Advanced Cardiac Life Support (ACLS) and Basic Life Support (BLS) are essential competencies for healthcare professionals managing emergencies. Structured training enhances theoretical knowledge and practical skills; however, retention over time remains a challenge, particularly among postgraduate residents. Objective: To evaluate the impact of structured ACLS and BLS training on theoretical knowledge and practical skills among postgraduate residents and to assess retention after one month. Materials and Methods: This observational analytical study included 100 postgraduate residents without prior PIMS/DR/RMC/IEC-UG-PG/2026/28 ethical certificate certification at a tertiary care hospital. Participants underwent structured training based on American Heart Association ECC 2025 guidelines, including didactic lectures, instructor-led demonstrations, interactive discussions, case-based simulations, and hands-on practice on manikins. Theoretical knowledge was assessed using a validated 25-item multiple-choice questionnaire, and practical skills were evaluated using a 15-item instructor-assessed checklist with manikin feedback. Assessments were conducted pre-training, immediately post-training, and at one-month follow-up. Results: Baseline knowledge and skill scores were low (total knowledge: 7.25 ± 1.80; compression: 25.9 ± 5.9%; ventilation: 24.7 ± 6.0%). Immediate post-training evaluations demonstrated significant improvements in knowledge (24.55 ± 1.15; p < 0.001) and practical skills (compression: 87.9 ± 5.3%; ventilation: 86.8 ± 5.4%; compression fraction: 66.4 ± 7.1%; instructor-assessed skill: 12.6 ± 1.1; p < 0.001). At one-month follow-up, scores declined (p < 0.001) but remained substantially above baseline (total knowledge: 16.60 ± 2.05; compression: 65.6 ± 5.7%; ventilation: 64.2 ± 5.6%; instructor-assessed skill: 9.8 ± 1.4), indicating partial retention. Conclusion: Structured ACLS and BLS training significantly improves both theoretical knowledge and practical skills among postgraduate residents. Partial decay within one month highlights the importance of periodic refresher courses and simulation-based practice to sustain clinical competence and emergency readiness.

Venepuncture is a frequent source of pain and anxiety in clinical settings, especially among patients needing repeated access. Vapocoolant sprays like ethyl chloride provide fast-acting, non-invasive pain relief by rapidly cooling skin and numbing nociceptors. Research has shown these sprays can significantly reduce venepuncture pain compared to no intervention. However, evidence is lacking on whether administering two consecutive sprays offers better analgesia than a single application. Adding a second spray could potentially enhance pain reduction with minimal additional effort—an important consideration for improving patient comfort in busy clinical environments. METHODS: A prospective, randomized comparative study was conducted on 64 patients in a teaching institute. Patients were randomized into Group A (one spray) and Group B (two sprays). Pain intensity was measured using the Visual Analog Scale (VAS) immediately, at 3 minutes, and at 5 minutes post-cannulation.Side effects were also recorded. RESULTS: Group B showed significantly lower pain incidence (31.25%) compared to Group A (59.38%) (p=0.045). Mean VAS scores at all time points were significantly lower in Group B (p<0.05). No adverse effects were observed in either group. CONCLUSION: Two sprays of ethyl chloride significantly reduce venepuncture-induced pain more effectively than a single spray, without compromising patient safety.

Virilization in females is an alarming presentation that warrants evaluation for androgen-secreting tumors. Ovarian sex cord–stromal tumors are rare and may present with hyperandrogenism, menstrual disturbance, and an adnexal mass. Early recognition is essential as surgical treatment can be curative, especially in adolescents where fertility preservation is important. Case report: A 17-year-old girl presented with primary amenorrhea and progressive virilization for two years, along with abdominal pain and a gradually enlarging abdominopelvic mass for one year. Clinical examination revealed hirsutism, acne, clitoromegaly, and an irregular firm abdominopelvic mass corresponding to approximately 16 weeks’ gestation size. Serum testosterone was markedly elevated (284 ng/dL). Pelvic ultrasonography suggested a left adnexal lesion, and MRI abdomen and pelvis demonstrated a left ovarian neoplasm measuring approximately 8.5 × 6.5 × 8.5 cm without evidence of ascites or metastasis. She underwent an exploratory laparotomy. A bosselated yellowish solid mobile left ovarian tumor measuring about 8.3 × 9.5 cm was excised. Histopathology and immunohistochemistry (CD99, inhibin, calretinin positive) confirmed granulosa cell tumor. Menstruation resumed four months after surgery and virilizing features gradually improved; clitoromegaly persisted on long-term follow-up. Conclusions: Primary amenorrhea with virilization in adolescents should prompt evaluation for androgen-secreting ovarian tumors. Timely imaging and hormonal assessment aid in diagnosis. Early surgical management offers excellent prognosis and supports reproductive potential.

Adenoidectomy is one of the most common pediatric ENT surgeries. An ideal adenoidectomy surgery should be safe with minimal bleeding, operative time along with postoperative improvement in symptoms. Conventional curettage adenoidectomy is a blind procedure and may result in residual tissue, injury to eustachian tube orifice and increased bleeding. Endoscopic-assisted powered adenoidectomy provides direct visualization and precise tissue removal. Objective: To compare the efficacy and safety of conventional adenoidectomy and endoscopic-assisted powered adenoidectomy. Materials and Methods This prospective comparative study was conducted in a tertiary care hospital on 100 children aged 5–15 years requiring adenoidectomy. Fifty patients underwent conventional curettage adenoidectomy (Group A) and fifty underwent endoscopic-assisted powered adenoidectomy using microdebrider (Group B). Operative time, blood loss, residual adenoid tissue, postoperative pain, recovery time, symptom relief and tympanogram changes were assessed. Results Children who underwent endoscopic-assisted powered adenoidectomy using microdebrider showed significantly less residual adenoid tissue(p<0.001), better postoperative symptom relief, less pain, faster recovery and improved middle ear pressure compared to conventional adenoidectomy. Operative time in group A-7.32 minutes, group B-18.00 minutes and intraoperative bleeding in group A-8.150ml and group B -16.600 ml was slightly longer in the powered group, but postoperative residual tissue (p<0.001),complications were less and had better postoperative symptomatic relief. Conclusion Endoscopic-assisted powered adenoidectomy is a safer and more effective technique than conventional curettage adenoidectomy, offering superior functional outcomes and reduced postoperative morbidity.

Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus. Macular involvement is the most frequent cause of visual loss in DR. Diabetic macular edema and clinically significant macular edema (CSME), as defined by the Early Treatment Diabetic Retinopathy Study, are characterized by retinal thickening and lipid exudation.⁵˒⁶ Hard exudates are lipid-rich deposits associated with chronic vascular leakage and dyslipidemia.⁹˒¹⁰ This study evaluates the association between retinal hard exudates and serum lipid profile in diabetic retinopathy. METHODS: Patients were divided into 2 groups. Group A consisted of 50 DR patients with CSME and Group B consisted of 50 DR patients without CSME. A comprehensive ophthalmic evaluation was performed in all patients. Fundus examination & OCT were done to assess the presence and severity of hard exudates. ETDRS classification was used for grading diabetic retinopathy. Lipid profile parameters were measured. Grading of severity of hard exudates was done using the modified Airlie House classification. RESULTS: This study highlights a significant association between dyslipidemia and the severity of retinal hard exudates in patients with DR. Increased severity of hard exudates was associated with elevated levels of total cholesterol, LDL-C, VLDL, and triglycerides, while lower HDL-C levels were linked to greater exudate severity. CONCLUSION: This study demonstrates a significant association between retinal hard exudates and serum lipid abnormalities in patients with DR. Increasing severity of hard exudates was strongly associated with elevated total cholesterol, LDL cholesterol, triglycerides, and VLDL levels, along with reduced HDL cholesterol levels.

Immunohistochemistry (IHC) is a cornerstone of modern oncologic pathology, enabling accurate tumor classification, prognostication, and therapeutic decision-making. Despite its widespread use, the diagnostic accuracy of many IHC markers varies across tumor types and testing methodologies, leading to uncertainty in clinical interpretation. Objective: To systematically evaluate and quantify the diagnostic accuracy of commonly used immunohistochemical markers in oncology through a systematic review and meta-analysis. Methods: A comprehensive literature search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library from inception to March 2025. Diagnostic accuracy studies evaluating IHC markers in malignant tumors were included. Study quality was assessed using the QUADAS-2 tool. Pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios were calculated using a random-effects bivariate model. Summary receiver operating characteristic (sROC) curves were generated to assess overall diagnostic performance. Results: A total of 128 studies comprising 24,691 tumor specimens were included. Hormone receptor markers and HER2 demonstrated high diagnostic accuracy, with pooled sensitivity and specificity exceeding 0.85 and area under the sROC curve (AUC) greater than 0.95 in breast carcinoma. Markers such as Ki-67, p53, and PD-L1 showed moderate diagnostic accuracy with significant heterogeneity across studies. Variability in antibody clones, scoring systems, and cut-off thresholds were major contributors to inter-study heterogeneity. Conclusion: Immunohistochemical markers demonstrate variable diagnostic accuracy depending on tumor context and methodological factors. While certain markers show robust and reproducible performance, others require cautious interpretation and standardized assessment. These findings underscore the importance of methodological harmonization and context-specific application of IHC markers to optimize diagnostic accuracy in oncologic practice.

Background:The term‘platelet storage lesion’ refers to detrimental changesthat occurinplatelet concentratesfrom the time of whole-blood processing, through storage and until they are transfused to the patient. The changes occur in the platelet cytoskeleton, which is evident by the change in morphology, biochemical parameters and changes in platelet indices. Methods: An observational studywas done on 107 samples of platelet concentrates, which were examined on day zero and five of preparation. Swirling, platelet indices, pH, glucose and morphology were assessed. P-selectin was measured on 40 platelet concentrate samples. To compare the measurements between day zero and day five for the same platelet concentrates, a paired t-test was used for continuous variables like platelet count, MPV, and pH to determine if the observed changes were statistically significant (with a p-value < 0.05 considered significant).Pearson's correlation coefficient (r) was used to assess the strength and direction of the linear relationships between key variables, such as P-selectin levels and morphology scores, with other biochemical and morphological parameters.Results:On examinationon the fifth day, 10% of the total number of platelet concentrate bags did not show swirling. There was a decrease in platelet count, Kunicki Morphology Score, glucose, and pH, while an increase was noted in Mean Platelet Volume(MPV), Platelet Distribution Width (PDW) and P-selectin over a period of five days.Conclusion:Significant changes were observed in various parameters of stored platelet concentrates over a period of 5 days. The mean platelet count of the platelet concentrates decreased (679±226.46 x103/µL to 418.18±212.62 x103/µL) (p<0.01).The average Kunicki Morphology Score of the platelet concentrates decreased (183.93±5.56to 160.67±10.45) (p<0.01). The calculated mean pH of platelet concentrates decreased (7.97±0.41to 6.79±0.33)(p<0.01). The mean glucose concentration of the platelet concentrates decreased (377.76±59.09 mg/dL to 264.31±84.35 mg/dL)(p<0.01). The platelet concentrates had an average mean platelet volume (MPV) which increased (7.30±1.07fL to 8.59±1.23fL)(p<0.01). The average PDW of the platelet concentrates (17.66±0.64to18.47±0.69) (p<0.01). P-selectin levels showedsignificant correlation with MPV, PDW and glucose levels (p<0.05). Morphology score showed a significant correlationwith pH, glucose levels and platelet count (p<0.05).All these parameters are reliable markers to determine the extent of platelet storage lesion. Numerous factors affectchanges in these parameters during storage, which should also be taken into consideration. However, further studiesmay be needed to understand the mechanism underlying platelet storage changes to help develop techniques toincrease the longevity of stored platelet concentrates.

Context: One-lung ventilation is a cornerstone technique in thoracic surgeries, facilitating surgical access by selectively ventilating one lung while allowing the other to collapse. Recent attention has focused on the role of arterial carbon dioxide tension (PaCO₂) in modulating oxygenation during OLV. Permissive hypercarbia, wherein PaCO₂ is deliberately maintained at levels slightly above normal, has been proposed to improve pulmonary mechanics and oxygenation. Aims: To evaluate the effects of hypercarbia on arterial oxygenation during one lung ventilation in thoracic surgeries Settings and Design: It was a prospective, randomized, comparative study. The study is registered at clinicaltrials.gov (registration quantity: CTRI/2024/05/067338), and all strategies adhered to the announcement of Helsinki pointers. Written knowledgeable consent was acquired from each participant. Methods and Material: In this prospective, randomized, comparative study, seventy-four patients (ASA I–II) undergoing elective lung surgical treatment with standard anaesthesia with OLV were similarly divided into two groups: Group A (normocarbia: PaCO₂ 38–42 mmHg) and Group B (permissive hypercarbia: PaCO₂ 45–50 mmHg). Arterial blood gases, hemodynamic parameters, and respiratory variables were measured during normocarbic and hypercarbic phases. Arterial oxygen partial pressure (PaO₂), arterial O₂ content (CaO₂), and O₂ delivery (DO₂) were the primary endpoints. Statistical analysis used: All the data were entered on M.S. Office Excel and analyzed statistically using SPSS Statistical software (ver. 22.0.0). Categorical data were presented as numbers (percentages) and compared between groups using the Chi-square test. Quantitative data were presented as mean ± standard deviation and compared using the Student's t-test. The Mann-Whitney U test was employed for comparing non-parametric data between the study groups, providing a robust analysis of differences in median values. A p-value of less than 0.05 was considered statistically significant. Results: Groups were demographically comparable. PaO₂ levels increased significantly during hypercarbia compared to normocarbia (366.38 ± 117.28 mmHg vs. 295.46 ± 118.41 mmHg, p = 0.012). Similarly, CaO₂ (16.16 ± 1.99 vs. 14.46 ± 1.58, p < 0.001) and DO₂ (71.81 ± 17.03 vs. 62.78 ± 20.1 mL/min, p = 0.041) were higher in the hypercarbia group. Lung compliance parameters did not differ significantly, except dynamic compliance, which was higher in the hypercarbia group (p < 0.001). Conclusions: Permissive hypercarbia significantly enhances arterial oxygenation and O₂-carrying capacity during OLV without causing detrimental hemodynamic shifts.

Background: Systemic inflammation is increasingly recognized as a key contributor to tumor development, progression, and aggressiveness. The neutrophil–lymphocyte (N/L) ratio, derived from routine complete blood counts, has emerged as a simple and cost-effective biomarker reflecting the balance between tumor-promoting inflammation and host immune surveillance. Objective: To evaluate the association between pre-treatment neutrophil–lymphocyte ratio and histopathological differentiation in patients with oral and oropharyngeal squamous cell carcinoma. Materials and Methods: This retrospective observational study included 117 patients with histologically confirmed oral and oropharyngeal squamous cell carcinoma. Pre-treatment complete blood counts were analyzed to calculate the neutrophil–lymphocyte ratio. Tumors were classified histopathologically as well differentiated, moderately differentiated, or poorly differentiated. Statistical analysis was performed to assess the association between N/L ratio and histopathological differentiation. Results: The mean neutrophil–lymphocyte ratio demonstrated a progressive increase with worsening histopathological differentiation. Mean N/L ratios were 4.64 ± 1.30 in well differentiated tumors, 4.47 ± 7.05 in moderately differentiated tumors, and 5.31 ± 3.23 in poorly differentiated tumors. This association between elevated N/L ratio and poorer differentiation was statistically significant (p < 0.05). (Kruskal–Wallis test). Conclusion: Pre-treatment neutrophil–lymphocyte ratio shows a significant association with histopathological differentiation in oral and oropharyngeal squamous cell carcinoma. Higher N/L ratios are associated with poorly differentiated tumors, suggesting that N/L ratio may serve as a simple adjunctive marker of aggressive tumor biology.

Introduction: Neonatal sepsis is a major cause of morbidity and mortality in newborns [3]. Obtaining blood cultures before initiating antimicrobial therapy is a cornerstone of evidence-based management. In our NICU, inconsistent blood culture collection, variable staff competency, and deviations from guideline-based workflows prompted a clinical audit and quality improvement (QI) initiative. Methods: A retrospective pre-audit was conducted from August to November 2024, including 87 neonates with suspected sepsis. Data on blood culture collection, CRP timing, antibiotic initiation, documentation, and adherence to clinical indicators were analyzed. Multiple training sessions, process redesign, and NICE-based flowchart implementation were performed. A post-audit was conducted from December 2024 to March 2025, including 98 neonates. Results: In the pre-audit, only 12/87 neonates (13.7%) underwent blood culture collection before antibiotics. Contributing factors included lack of vials, untrained staff, unclear responsibilities, and delayed CRP reporting. After the QI intervention, compliance improved significantly to 63/98 neonates (64.3%). Staff knowledge, aseptic sampling technique, hand-hygiene compliance, and documentation improved on post-audit evaluation. Conclusion: Major gaps were identified in pre-audit neonatal sepsis management. Structured training, improved logistics, and standardized workflow implementation resulted in substantial improvement in compliance. Continued re-audits and reinforcement are required to reach the target ≥90% compliance.

Introduction: Traditionally, elevated intraocular pressure (IOP) has been considered the most important risk factor for glaucoma development and progression. However, a subset of patients continue to show progressive optic nerve damage despite having IOP within the normal range. Studying the relationship between Ocular Perfusion pressure (OPP) and Cup-Disc ratio (CDR) is important in understanding the vascular contribution to glaucoma pathogenesis. Such evidence may have clinical implications emphasizing systemic vascular health and blood pressure regulation⁵,⁷. Methods: A cross-sectional, observational study was conducted in a tertiary health care centre in Kerala during a period of 18 months. Systemic blood pressure and IOP by Goldmann applanation tonometer were measured. Mean arterial pressure (MAP) was calculated with the formula MAP=DBP+1/3(SBP-DBP). OPP was derived using the formula OPP = 2/3MAP– IOP. The CDR was assessed by fundus examination and Optical coherence tomography-Retinal nerve fibre layer (OCT-RNFL). Statistical analysis was performed to assess the relationship. Results: In 94 POAG patients aged more than 40 years, the mean OPP was 47.51 mmHg and the mean CDR in the worse eye was 0.78. A significant inverse correlation was found between OPP and CDR, suggesting that lower OPP is associated with advanced optic nerve cupping in patients with POAG. Conclusion: This study found a significant inverse correlation between ocular perfusion pressure and CDR in POAG patients. Lower OPP was linked to greater optic nerve damage, highlighting the role of vascular factors in glaucoma. Routine OPP monitoring may help identify high-risk patients, guide individualized treatment, and potentially slow disease progression.

Background:Clavicle fractures are common orthopedic injuries, frequently affecting young and active adults. Traditionally managed conservatively, an increasing preference for surgical intervention specifically open reduction and internal fixation (ORIF) with plating has emerged due to evidence of superior functional and radiological outcomes, especially in displaced midshaft fractures. Materials and Methods: The study was conducted for 18 months with a prospective observational study design enrolling 55 adult patients with displaced clavicle fractures, treated with ORIF plating. Clinical evaluation and radiographic classification was done pre operatively, followed by standardized surgical protocols using locking compression plates (LCP), dynamic compression plates (DCP) or hook plates. With the help of Disabilities of the Arm, Shoulder and Hand score (DASH), functional outcomes were assessed at 2, 6 and 12 weeks. Radiological union and complications were recorded and data was analysed using appropriate statistical tests. Results: The study population majorly constituted with males (72.7%), diagnosed with midshaft fractures (76.4%), more frequent on the right side (58.2%). Road traffic accidents were identified as the leading cause. LCP was the most commonly used implant (65.5%). The functional outcomes improved significantly from 85.4 mean DASH score preoperatively to 28.6 at 12 weeks. Around 76.4% of patients achieved excellent or good outcomes. The mean union time was 9.2 weeks and union rate exceeded 92%. Complications were less and occurred only in 32.7% patients mainly in patients with infection or implant irritation. Type of fracture, displacement and implant selection along with complications, significantly affected recovery and DASH scores. Conclusion: ORIF with plating yields excellent functional and radiological outcomes in displaced clavicle fractures, particularly midshaft injuries, with high union rates and early return of shoulder function. Careful implant selection and complication avoidance are essential for optimal results, supporting surgical management in active adult populations.

Background: Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for benign prostatic hyperplasia (BPH). However, the relationship between the extent of tissue resection and postoperative clinical improvement remains unclear. Residual prostatic weight ratio (RPWR) has emerged as a potential indicator of surgical adequacy. Objective: To assess the impact of residual prostatic weight ratio on symptom improvement and functional recovery following TURP in patients with benign prostatic hyperplasia. Materials and Methods: This prospective correlative study included 50 patients with symptomatic BPH undergoing TURP. Preoperative and 6 month postoperative International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and average urinary flow rate (Qavg) were compared. RPWR was calculated as the ratio of residual prostate weight after TURP to initial prostate weight. Statistical analysis evaluated correlations between RPWR and postoperative outcomes. Results: The mean age was 68.96 ± 8.7 years, and the mean prostate weight was 66.06 ± 16.8 g. Mean RPWR was 0.17 ± 0.07 (range 0.07–0.50). Significant improvements were observed in IPSS, Qmax, and Qavg at 6 months postoperatively (p < 0.001). Lower RPWR values were associated with greater symptom relief and superior improvement in urinary flow parameters, demonstrating a negative correlation between RPWR and clinical outcomes. Conclusion: RPWR shows a measurable association with symptom improvement and functional recovery following TURP. Lower RPWR values tend to predict better postoperative outcomes, suggesting RPWR may be a useful adjunctive parameter for evaluating surgical adequacy.

Background: Anaemia and nutritional deficiencies remain major contributors to childhood morbidity in India, often sustained by inadequate dietary knowledge and limited awareness of preventive programs. School-aged children, particularly in hilly regions like Himachal Pradesh, face unique nutritional challenges due to dietary monotony, harsh climate, and varying access to health education. This study assessed the awareness of anaemia, nutritional deficiencies, and related health initiatives among school-going children in the state. Materials and Methods: A descriptive cross-sectional study was conducted from January to April 2025 among 420 students aged 10–16 years, selected through stratified random sampling from government and private schools in Shimla, Kangra, and Chamba districts. A validated questionnaire assessed socio-demographic characteristics, knowledge of anaemia and nutritional deficiencies, and awareness of health programs such as Anaemia Mukt Bharat and WIFS. Each correct answer was scored as one, and awareness levels were categorized as excellent (≥75%), good (50–74%), fair (25–49%), or poor (<25%). Data were analyzed using SPSS v26.0 with descriptive and chi-square tests (p < 0.05). Results: Overall awareness was moderate but varied across domains. Knowledge regarding anaemia was comparatively higher, with 22.9% of participants demonstrating excellent awareness and a mean score of 7.4 ± 1.8. Awareness of nutritional deficiencies was slightly lower (mean = 7.1 ± 1.9), with gaps observed in understanding vitamin B₁₂, iodine, and vitamin C deficiencies. The lowest awareness was recorded for health programs and practices (mean = 6.6 ± 2.0), where fewer students knew about the frequency of IFA tablet intake, the role of deworming, or the purpose of Anaemia Mukt Bharat. Misconceptions regarding iron absorption and limited familiarity with community health initiatives were notable. Conclusion: While children exhibited fair knowledge of anaemia and basic nutrition, their understanding of government health programs was limited. Strengthening school-based nutrition education, empowering teachers as health mentors, and promoting active participation in national programs are crucial to bridge this awareness–practice gap.

Introduction: This randomized trial was performed to compare continuous ultrasound guided pericapsular nerve group (PENG) block, and continuous suprainguinal fascia iliaca block (SFIB) for post-operative analgesic efficacy after hip surgeries. Methods: Forty-eight patients of either sex in the age group of 18 to 85 years scheduled to undergo unilateral hip surgery under subarachnoid block were allocated into two groups by an online randomization system. In Group A, patients received ultrasound guided continuous pericapsular nerve group block (n=24) and in Group B, patients received ultrasound guided continuous suprainguinal fascia iliaca block (n=24). In the post-operative period rescue analgesia of Inj. tramadol 1mg/kg was administered when pain scores were 3 or greater. A blinded observer assessed static and dynamic pain score pain score at fixed time points, during the first 36 hours after the surgery. Quadriceps muscle weakness and patient satisfaction score were also assessed post operatively. Results: The total analgesic consumption in terms of morphine equivalent and static and dynamic nVRS pain score in were significantly lower than group B in the first 36 hours postoperative period. No quadriceps muscle weakness was found in both the group at 24 and 36 hours. The Patient satisfaction score in the PENG group was greater than the SFIB group. Conclusions: For unilateral hip surgery, in comparison to continuous suprainguinal fascia iliaca block (SFIB); continuous pericapsular nerve group block demonstrated superior analgesic efficacy. Trial registration number: CTRI/2021/03/032161

Background: Dental caries remains one of the most prevalent chronic oral diseases worldwide, despite being largely preventable. In India, changing dietary habits, inadequate oral hygiene practices, and irregular dental visits have contributed to the persistent burden of dental caries. Himachal Pradesh, with its unique geographic and healthcare accessibility challenges, may be particularly vulnerable. Understanding public awareness and preventive practices is essential for planning effective oral health interventions. Materials and Methods: A community-based, cross-sectional study was conducted from January to April 2025 among 420 adults residing in urban and semi-urban areas of Himachal Pradesh. Data were collected using a validated, structured, self-administered questionnaire assessing socio-demographic characteristics, awareness regarding dental caries, and preventive practices. Awareness and practice scores were categorized as excellent, good, fair, or poor. Data were analyzed using IBM SPSS version 26, applying descriptive statistics and the Chi-square test to assess associations, with p < 0.05 considered statistically significant. Results: Overall awareness regarding dental caries was moderate to good, with 64.8% of participants demonstrating good to excellent knowledge. Most respondents correctly identified the role of bacteria, sugars, and poor oral hygiene in dental caries development. However, preventive practices were suboptimal, as only 62.4% exhibited positive preventive behaviors, and nearly half of the participants visited dental clinics only when experiencing pain. Awareness and preventive practices showed significant associations with education level, occupation, income, age, and area of residence (p < 0.05), while gender showed no significant association. Conclusion: Despite satisfactory awareness regarding dental caries among the general population of Himachal Pradesh, preventive practices remain inadequate, indicating a clear knowledge–practice gap. Educational and socio-economic factors play a significant role in shaping oral health behavior. Strengthening community-based, behavior-oriented oral health promotion programs and improving access to preventive dental care are essential to reduce the burden of dental caries in this region.

Background: Urinary cytology is a widely used, non-invasive investigation for the detection and surveillance of urothelial carcinoma of the bladder. However, its diagnostic accuracy, particularly in low-grade tumours, remains controversial. Objectives: To evaluate the diagnostic performance of urinary cytology and to correlate cytological findings with histopathological examination in patients with transitional cell carcinoma (TCC) of the urinary bladder. Materials and Methods: This prospective observational study was conducted at a tertiary care centre from July 2023 to June 2025. Voided urine samples from 59 patients with suspected bladder tumours were analysed using the Paris System for Reporting Urinary Cytology. All patients subsequently underwent transurethral resection of bladder tumour (TURBT), and histopathological examination (HPE) served as the reference standard. Sensitivity, specificity, predictive values, diagnostic accuracy, and kappa agreement were calculated. Results: Of the 59 patients, histopathology confirmed urothelial carcinoma in 56 cases (94.9%). Urinary cytology was positive in 15 cases (25.4%). The sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of urine cytology were 25.0%, 66.7%, 93.3%, 4.6%, and 27.1%, respectively. Agreement between cytology and histopathology was poor (κ = −0.011, p = 0.747). Cytology demonstrated better performance in high-grade tumours compared to low-grade lesions. Conclusion: Urinary cytology demonstrates high specificity and positive predictive value for the detection of urothelial carcinoma of the bladder; however, its low sensitivity and poor negative predictive value limit its utility as a standalone diagnostic modality. Cytology is most effective as an adjunct to cystoscopy and histopathology, particularly for confirmation and surveillance of high-grade disease. Negative cytological findings should not preclude further evaluation when clinical suspicion persists.

Introduction: Diabetic neuropathy (DN) in type 2 diabetes (T2D) is heterogeneous, ranging from distal symmetric polyneuropathy (DSPN) and painful diabetic peripheral neuropathy (PDPN) to autonomic neuropathy and focal mononeuropathies. Contemporary standards recommend routine screening starting at T2D diagnosis and at least annually thereafter to reduce foot complications and improve quality of life. Materials and Methods: A hospital-based cross-sectional observational study was designed among adults with T2D attending outpatient/endocrine clinics. Participants underwent structured symptom assessment, neurological examination, neuropathy screening instruments (e.g., MNSI/DN4), bedside sensory testing, and targeted confirmatory tests (nerve conduction studies for large-fiber disease; autonomic function tests for suspected autonomic neuropathy). The primary outcome was prevalence of neuropathy phenotypes; secondary outcomes included severity grading, risk-factor associations, and foot-risk stratification. Results: DSPN was the commonest phenotype, followed by PDPN and autonomic neuropathy. Neuropathy prevalence increased with longer diabetes duration, poor glycemic control, and coexisting microvascular complications. A proportion had mixed phenotypes (DSPN + PDPN and/or autonomic features), highlighting the need for structured phenotyping rather than single-test screening. Conclusion: DN in T2D exists on a spectrum with overlapping phenotypes. A combined approach—symptom inquiry, focused examination, and selective confirmatory testing—identifies clinically meaningful subgroups for pain management, autonomic risk reduction, and ulcer prevention.

Background: Pediatric gallstone disease, once considered rare, is increasingly recognized due to improved imaging and heightened clinical awareness. Unlike adults, pigment gallstones predominate in children, often secondary to chronic hemolysis. Hemolytic disorders contribute to sustained bilirubin overproduction, predisposing affected children to gallstone formation and related complications. Objectives: To determine the Prevalance of hemolytic disorders among pediatric patients with gallstone disease, describe the spectrum of underlying hemolytic conditions, and evaluate their clinical presentation, management, and outcomes. Methods: A retrospective observational study was conducted at a tertiary care hospital over a one-year period (December 2024–December 2025). Children ≤18 years with ultrasonographically confirmed gallstones were included. Demographic data, clinical features, laboratory parameters, hemolytic work-up, imaging findings, and treatment outcomes were analyzed. Statistical comparisons between hemolytic and non-hemolytic groups were performed using appropriate parametric and non-parametric tests. A p-value <0.05 was considered statistically significant. Results: Among 40 pediatric patients with gallstone disease, 15 (37.5%; 95% CI: 22.7–52.3) had underlying hemolytic disorders. Sickle cell disease was the most common etiology (53.3%), followed by hereditary spherocytosis (26.7%). Jaundice was significantly more frequent in the hemolytic group compared with the non-hemolytic group (60% vs. 12%; p = 0.003), with a risk difference of 48% (95% CI: 20.1–67.9). Mean hospital stay was significantly longer in children with hemolytic disorders (5.1 ± 1.2 vs. 3.6 ± 1.0 days; p = 0.001). Rates of cholecystectomy and postoperative complications did not differ significantly between groups. Conclusion: Hemolytic disorders account for a substantial proportion of pediatric gallstone disease, with sickle cell disease and hereditary spherocytosis being the predominant contributors. Early identification and multidisciplinary management are crucial to prevent biliary complications and optimize surgical outcomes.

Introduction: Intraarticular distal femur fractures are high-velocityinjuries traditionally managed with open reduction internal fixation with distal femur locking compression plating. However, in fractures involving the medial column the use of a lateral distal femur locking compression plate alone leads to varus collapse and delayed union. The addition of Titanium elastic nailing system (TENS) supports the medial column and prevents varus collapse and promotes early fracture healing. This study compares the functional and radiological outcomes of comminuted distal femur fracturesmanaged with lateral distal femur locking compression plating alone and those with lateral distal femur locking compression plating with TENS. Materials and Methods: This prospective randomised interventional comparative study was conducted at our tertiary care institute on 30 patients of AO type C distal femur fractures. They were assigned into two cohorts of 15 patients each based on simple random sampling; Group A managed with DFLCP and Group B with DFLCP and TENS. This study population also included patients with open injuries. All these patients were followed up for 1 year and assessed for functional and radiological outcomes. Results: There was a significant difference observed in the average time taken for complete union between both the groups; 17.14 ± 2.07 weeks in Group A and 15.33 ± 1.72 weeks in Group B respectively. Among Group A patients, five had varus angulation, two patients had implant failure, and one patient had non-union status; whereas in Group B there were no cases of varus angulation and complications related to fracture healing. Conclusion: The addition of TENS along with DFLCP for AO type C distal femur fracture obviates the need for medial column plating. This minimally invasive procedure significantly reduces the operative time and at the same time prevents varus collapse and establishes column alignment of distal femur, early bony union and improved functional outcomesof the knee.

Background: Ocular fungal infections represent a significant cause of visual morbidity, particularly in tropical and developing countries. Early diagnosis and appropriate antifungal therapy depend heavily on the understanding of local microbiological profiles. Objectives: To evaluate the microbiological spectrum, demographic characteristics, predisposing factors, and clinical patterns of ocular fungal infections at a tertiary ophthalmic referral hospital. Methods: This observational study was conducted over a period of 18 months at an ophthalmic referral center. Patients clinically suspected of ocular fungal infection were enrolled. Corneal scrapings, conjunctival swabs, aqueous/vitreous samples were subjected to direct microscopy (KOH mount, Gram stain) and fungal culture. Isolates were identified based on colony morphology and microscopic characteristics. Results: A total of 142 clinically suspected cases were included, of which 96 (67.6%) were microbiologically confirmed fungal infections. The most commonly isolated fungi were Aspergillus species (42.7%), followed by Fusarium species (31.3%), Candida species (12.5%), and dematiaceous fungi (8.3%). Ocular trauma with vegetative matter was the most common predisposing factor (54.1%). Fungal keratitis constituted the predominant clinical presentation (81.2%). Conclusion: Filamentous fungi, particularly Aspergillus and Fusarium, remain the leading causative agents of ocular fungal infections. Awareness of regional fungal profiles is essential for prompt diagnosis and effective management to prevent vision-threatening complications.

Introduction: Road-traffic accidents (RTA) are increasing at an alarming rate and majority of them occur in middle and low income countries like India causing tremendous burden of disability and loss of GDP. In developed countries, data is available from vital statistics registers and health care records. However, such records are limited in developing countries and hence the need for descriptive studies addressing the same. Aims & Objectives: This retrospective observational study aims to scrutinize the demographics and the mortality trends of trauma patients admitted to the intensive care unit (ICU) at a Level 1 Trauma centre and Superspeciality hospital in North India which caters to a large part of eastern and central Indian population. Materials & Methods: The particulars of 1571 patients admitted to the intensive care unit at the Trauma Centre, retrospectively, in the time frame between 1st January 2018 and 31st December 2019 were retrieved, tabulated and analysed using descriptive statistics. Results: Indices such as mortality, average length of ICU stay, bed turnover rate, bed occupancy rate, admission rate, gross death rate and institutional death rate were calculated, analysed, compared and reported. Conclusion: Road traffic accidents related morbidity and mortality are a significant public health problem worldwide and by improving our system and better monitoring of the reality of healthcare with better reporting and documentation of cases like trauma registry, we shall be able to plan timely appropriate multimodality approaches to achieve better outcome of cases within our limited resources.

Introduction: Dermatophytosis is a common superficial fungal infection of the skin, hair, and nails caused by keratinophilic fungi known as dermatophytes. The epidemiological profile and the predominant species vary significantly with geographical location, climate, and socioeconomic factors. Recent years have witnessed an alarming increase in chronic, recurrent, and recalcitrant dermatophytosis, necessitating ongoing surveillance of the causative species for effective management. Material and Methods: A prospective, cross-sectional study was conducted over 18 months from January 2023 to June 2024 in the Dermatology Outpatient Department. A total of 350 patients with clinically suspected dermatophytosis were enrolled. Skin scrapings, hair pluckings, and nail clippings were collected from each patient. Direct microscopic examination with 10% Potassium Hydroxide (KOH) and fungal culture on Sabouraud Dextrose Agar with cycloheximide and chloramphenicol were performed for confirmation and identification. Result: Out of 350 samples, 210 (60%) were confirmed as dermatophytosis by either KOH mount and/or culture. The male-to-female ratio was 1.5:1, with the most affected age group being 21-40 years (45.2%). Tinea corporis was the most common clinical presentation (38.1%). Culture positivity was 55.7% (117/210), and Trichophyton mentagrophytes complex was the predominant isolate (52.1%), followed by Trichophyton rubrum (35.9%) and Microsporum canis (6.0%). Conclusion: The study confirms a high prevalence of dermatophytosis in our region, with a notable shift in the dominant species from T. rubrum to T. mentagrophytes complex. This change in the etiological spectrum has significant therapeutic implications, guiding clinicians towards more appropriate antifungal therapy.

Background: Immunohistochemistry (IHC) plays a pivotal role in oncologic diagnosis and biomarker evaluation; however, the diagnostic accuracy of IHC markers varies across tumor types and laboratory practices. This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used immunohistochemical markers in oncology. Methods: A comprehensive literature search was conducted to identify diagnostic accuracy studies comparing IHC markers with established reference standards. Methodological quality was evaluated using the QUADAS-2 tool. Pooled sensitivity and specificity were calculated using a bivariate random-effects model, and overall diagnostic performance was summarized using summary receiver operating characteristic (SROC) analysis. Results: Thirty-four studies were included in the qualitative synthesis, and 28 studies were eligible for quantitative meta-analysis. Immunohistochemical markers demonstrated high overall diagnostic accuracy, with pooled sensitivity of 0.82 and specificity of 0.91. Lineage-specific markers showed consistently high specificity, whereas predictive and molecular surrogate markers exhibited greater variability in sensitivity. Between-study heterogeneity was moderate and was partly attributable to differences in antibody clones and scoring methodologies. Conclusions: Immunohistochemical markers remain reliable diagnostic tools in oncology, particularly for tumor classification. Standardization of immunohistochemical assays and integration with molecular diagnostics are essential to minimize variability and optimize clinical decision-making.

Introduction- The interrelationship of psychiatry and dermatology has gained immense recognition owing to the complex relationship between psychiatric comorbidities and dermatological conditions. Despite this growing recognition, comprehensive data concerning clinical characteristics, prevalence, and treatment outcomes in dermatology subjects with psychiatric comorbidities are scarce. The present study was conducted to assess the prevalence of depression, anxiety, and stress among dermatology patients and to evaluate their association with socio-demographic and clinical factors at a tertiary care hospital. Material and methods- This cross-sectional study was conducted over one year in the dermatology outpatient department in collaboration with the psychiatry department of a tertiary care hospital. A total of 230 patients aged 18–60 years with dermatological disorders of at least four weeks’ duration were included using convenience sampling. Socio-demographic and clinical data were recorded using a structured proforma. Psychiatric morbidity was assessed using the Depression Anxiety Stress Scale–21 (DASS-21). Statistical analysis was performed using SPSS version 25.0, and associations were tested using Chi-square test, with p < 0.05 considered statistically significant. Results – Psoriasis was the most commonly observed dermatological disorder (20.9%), followed by acne vulgaris (19.1%) and eczema (17.0%). Pigmentary disorders such as vitiligo accounted for 12.2% of cases. Overall psychiatric morbidity was detected in 57.4% of dermatology patients. Anxiety was the most prevalent condition (47.0%), followed by depression (40.0%) and stress (33.0%). Moderate severity levels were most frequently observed across all psychiatric domains. Severe depression, anxiety, and stress were present in 8.7%, 9.1%, and 7.0% of patients respectively. The mean anxiety score (15.6 ± 7.1) was higher than depression and stress scores. A statistically significant association was observed between longer duration of dermatological illness (>6 months) and the presence of depression, anxiety, and stress (p < 0.05). Conclusion- Patients in dermatology, especially those with long-term skin disorders, frequently have psychiatric comorbidities. In order to enhance overall patient outcomes, routine mental health screening and a multidisciplinary approach to dermatological care are essential, as evidenced by the strong correlation between psychological discomfort and sociodemographic and clinical parameters.

Background: Veno-renal anomalies are uncommon congenital malformations of the venous system and urinary tract. We report a rare concurrence of three anomalies namely, right retrocaval ureter, duplicated infrarenal inferior vena cava, and congenital solitary kidney present in a young woman with complaints of right flank pain. Diagnosis was established with CT urography and retrograde pyelography. Laparoscopic transperitoneal ureteric resection with ureteroureterostomy was performed, with uneventful recovery and preserved renal function. Awareness of such anomalies is crucial for surgical planning and prevention of vascular complications.

Background: Genetic testing is increasingly central to diagnosing neurological disorders, especially those with early-onset, syndromic, or familial features. In low-resource settings like South India, its clinical utility remains underexplored, particularly in consanguineous populations. Objectives: To evaluate the diagnostic yield and clinical utility of genetic testing in suspected neurogenetic disorders at a tertiary neurology center in South India. Methods: This retrospective study included 32 patients who underwent genetic testing between February 2023 and February 2025. Clinical and genetic data were analyzed to determine diagnostic yield—defined as pathogenic/likely pathogenic (P/LP) variants—and its association with demographic, clinical, and testing variables. Statistical analyses used odds ratios and Fisher’s exact test. Results: The overall diagnostic yield was 37%. Gene panels (60%) and repeat expansion assays (66.7%) outperformed whole exome sequencing (42.8%). Epilepsy, ataxia, and movement disorder phenotypes had the highest yields (~66.7%), while neurodevelopmental disorders and autism had none (p = 0.003). Consanguinity was present in 19%, with 83% of these showing homozygous variants (OR = 5.0). Variants of uncertain significance (VUS) occurred in 47%, mainly in early-onset disorders and consanguineous families. Comparative global data confirmed the advantage of phenotype-guided testing, particularly in resource-limited settings. Conclusions: Targeted genetic testing informed by precise clinical phenotyping improves diagnostic yield in neurogenetic disorders, especially in consanguineous populations. The findings emphasize the value of homozygosity mapping, the challenge of VUS interpretation, and the need for population-specific variant databases to optimize genetic diagnostics in low- and middle-income regions.

Background: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting fertility, and thyroid dysfunction has been implicated in reproductive disturbances. This study aimed to evaluate the relationship between thyroid dysfunction and fertility outcomes in women with PCOS. Methods: A cross-sectional study was conducted involving 200 women diagnosed with PCOS at a tertiary care center. Participants underwent clinical evaluation, hormonal profiling including thyroid function tests, and assessment of fertility parameters such as menstrual regularity, ovulatory status, conception, and miscarriage rates. Statistical analysis was performed to compare outcomes between women with and without thyroid dysfunction. Results: Thyroid dysfunction was identified in 32% of women, predominantly hypothyroidism. Those with thyroid dysfunction exhibited significantly higher rates of menstrual irregularity (81.3% vs. 52.2%, p < 0.001) and ovulatory dysfunction (75.0% vs. 53.7%, p = 0.001) compared to euthyroid women. Fertility outcomes were adversely affected, with lower conception rates (23.4% vs. 44.9%, p = 0.002), higher miscarriage rates (12.5% vs. 4.4%, p = 0.024), and longer time to conception (14.6 vs. 10.2 months, p < 0.001) observed in the thyroid dysfunction group. Conclusion: Thyroid dysfunction is prevalent among women with PCOS and is associated with poorer fertility outcomes. Routine thyroid screening and management should be integrated into the care of women with PCOS to improve reproductive success.

Background: Early detection of large vessel occlusion (LVO) in acute ischemic stroke (AIS) cases is crucial for quick triage and initiating endovascular therapy. Prehospital stroke assessments like the Rapid Arterial Occlusion Evaluation (RACE) and the Vision, Aphasia, Neglect (VAN) scores aim to rapidly identify LVO. Nonetheless, there is limited comparative data on their effectiveness across clinical settings. Objectives: To evaluate the predictive accuracy of the RACE scale for identifying LVO in anterior circulation AIS and to compare its performance with the VAN score and the National Institutes of Health Stroke Scale (NIHSS). Materials and Methods: This cross-sectional observational study was conducted at a tertiary-care teaching hospital from 2023 to 2025. It included 105 consecutive patients with suspected anterior circulation AIS. Each patient was assessed clinically with RACE, VAN, and NIHSS scores, followed by CT or MR angiography to verify LVO. The study analyzed diagnostic performance, ROC curves, and statistical correlations using SPSS. Results: The mean age of patients was 59.00 ± 15.66 years, with males accounting for 64.8%. Radiologically confirmed LVO was found in 84.8% of cases. The mean RACE score was 4.97 ± 1.88, and the mean NIHSS score was 12.50 ± 6.28. The RACE score showed high diagnostic accuracy, with an AUC of 0.905 (95% CI: 0.848–0.962) and an optimal cut-off of ≥5. It achieved 100% specificity and positive predictive value, with a sensitivity of 73.03% and overall accuracy of 77.13%. The VAN score had high sensitivity (91.01%) but low specificity (50%). No significant links were found between LVO and sex, diabetes, or hypertension. Conclusion: The RACE scale is a dependable and useful prehospital tool for identifying LVO in anterior circulation AIS. Its high specificity and predictive value justify its routine use to improve stroke triage and expedite endovascular treatment.

Background: Fractures of the proximal femur are among the most frequently encountered injuries in orthopaedic practice and are associated with significant morbidity and mortality. Aim: To compare the Radiological and Functional Outcome of Subtrochanteric Fractures treated with proximal femoral nail (LONG PFN A2) and locking plate. Methodology: The present study was designed as a hospital-based prospective randomized study conducted in the Department of Orthopaedics, S.M.S. Hospital, Jaipur, over a period from May 2012 to December 2013. Result: LONG PFN A2 showed better functional outcomes, shorter operative time, less blood loss, lower infection rates, and earlier rehabilitation compared to LCP, while union rates were comparable in both groups. Overall, intramedullary fixation with LONG PFN A2 proved superior to extramedullary plating for subtrochanteric femoral fractures, despite similar radiological union times. Conclusion: Considering functional outcome and fracture biology, LONG PFN A2 is a safe and reliable implant for subtrochanteric femoral fractures, offering biological fixation with minimal soft-tissue damage and favorable biomechanics.Despite being technically demanding, meticulous planning and precise technique result in high union rates, early rehabilitation, and good functional outcomes.

Background: Trochanteric fractures are among the most common injuries encountered in orthopaedic practice, predominantly affecting patients over sixty years of age. AIM: The aim of this study is to compare and evaluate the long-term radiological and functional outcomes of dynamic hip screw (DHS) versus proximal femoral nail antirotation-2 (PFNA-2) fixation in the management of two-part (AO/OTA 31-A1) intertrochanteric femoral fractures in adult patients. Methodology: This was a prospective randomized comparative study conducted to evaluate and compare dynamic hip screw (DHS) fixation with proximal femoral nail antirotation-2 (PFNA-2) in the treatment of intertrochanteric femoral fractures in adult and elderly patients. Result: Most patients were over 60 years of age, with the PFNA-2 group showing shorter incision length, reduced operative time and blood loss, earlier ambulation, fewer complications, and higher mean Harris Hip Scores compared to the DHS group. Both groups achieved similar fracture union rates, but PFNA-2 demonstrated superior functional outcomes and fewer implant-related failures in AO/OTA 31-A1 intertrochanteric femoral fractures. Conclusion: PFNA-2 fixation demonstrated shorter operative time, less blood loss, smaller incisions, fewer radiographic complications, and superior postoperative Harris Hip Scores compared to DHS in AO/OTA 31-A1 intertrochanteric femoral fractures. Therefore, PFNA-2 is a more effective and reliable implant than DHS for the management of stable intertrochanteric femoral fractures in adults.

Background: Introduction: Giant cell tumor (GCT) of bone is a benign but locally aggressive neoplasm that predominantly affects the epiphyseal region of long bones in skeletally mature individuals. AIM: The present study was conducted to analyse functional outcome of giant cell tumor of distal end radius treated by en-bloc resection and reconstruction by ulnar translocation. Methodology: This hospital-based prospective interventional study was conducted on a cohort of patients who underwent surgical treatment for giant cell tumor of the distal end of the radius. Result: Our study demonstrated satisfactory functional and radiological outcomes with ulnar translocation, showing better forearm rotation, grip strength, earlier union, and a markedly lower recurrence rate compared to fibular graft–based reconstructions reported in the literature. Overall, ulnar translocation with wrist arthrodesis provided reliable union, fewer complications, and good hand function following aggressive excision of distal radius giant cell tumor. Conclusion: En-bloc excision of distal radius giant cell tumor with ulnar translocation and wrist arthrodesis is a reliable treatment that provides biological union, a stable painless wrist, and good functional outcomes. It offers low recurrence and complication rates, preserves forearm rotation, and ensures high patient satisfaction both functionally and cosmetically.

Background: Perforated appendicitis presenting with clinical and radiological findings suggestive of ruptured ectopic pregnancy is uncommon. This case highlights the diagnostic challenge of distinguishing between acute gynecological emergencies and acute abdomen of gastrointestinal origin, particularly in reproductive-aged women presenting with elevated β-hCG. Case Summary: A young female presented to the emergency department with acute abdominal pain, positive pregnancy test, and elevated β-hCG. Imaging revealed a complex left adnexal mass and free fluid, raising suspicion for ruptured ectopic pregnancy. Emergency exploratory laparotomy revealed perforated appendicitis with suppurative peritonitis rather than gynecological pathology. Conclusion: Perforated appendicitis can mimic ruptured ectopic pregnancy in reproductive-aged women. Careful clinical assessment, appropriate use of imaging modalities including CT scan and MRI when ultrasound is equivocal, and consideration of non-gynecological causes of acute pelvic pain are essential for accurate diagnosis and optimal patient outcomes. Intraoperative findings remain the gold standard for definitive diagnosis in ambiguous cases.

Introduction: Preoperative templating is a valuable and widely accepted tool in the planning of total hip arthroplasty (THA), assisting surgeons in determining the appropriate size, alignment, and positioning of prosthetic components.] Aim: To determine the relation between Templated implant size & Chosen implant size in Total Hip Arthroplasty Patients in view of Limb Length Discrepancy. Methodology: The study was conducted in the Department of Orthopedics, Dr. S. N. Medical College, Jodhpur, as a retrospective observational study over a one-year period from February 2023 to February 2024. Result: Preoperative templating demonstrated high accuracy and correlation with implanted component sizes, with femoral stem accuracy of 80% within ±1 size (PCC = 0.998) and acetabular shell accuracy of 63.3% within ±1 size (PCC = 0.990). Radiological limb length restoration was satisfactory, with 87% of patients achieving leg length equality within ±10 mm, a range generally considered clinically insignificant. Conclusion: Preoperative templating in uncemented total hip arthroplasty demonstrated acceptable accuracy for femoral stem sizing, while accuracy for the acetabular component was comparatively lower, though clinically useful. Templating serves as an essential preoperative planning tool that aids restoration of leg length and biomechanics but cannot replace intraoperative judgement and surgical experience.

Background: Mammography is the standard screening modality for breast cancer; however, its sensitivity is significantly reduced in women with dense breast tissue due to masking by fibroglandular parenchyma. Magnetic resonance imaging (MRI), which is not affected by breast density, has emerged as a potential alternative or adjunct screening tool, but its comparative diagnostic performance in dense breasts remains incompletely defined. Objective: To systematically review and meta-analyze the diagnostic accuracy of MRI versus mammography for the detection of breast cancer in women with dense breast tissue. Methods: A systematic literature search of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library was conducted in accordance with PRISMA 2020 guidelines. Studies comparing contrast-enhanced breast MRI and mammography in women with heterogeneously dense or extremely dense breasts (BI-RADS C/D) were included. Pooled estimates of sensitivity, specificity, cancer detection rate, interval cancer rate, and false-positive outcomes were calculated using a random-effects meta-analysis model. Results: Eighteen studies encompassing 87,412 women with dense breasts were included, of which 14 contributed to quantitative synthesis. MRI demonstrated significantly higher pooled sensitivity than mammography (93.4% vs 48.1%), while mammography showed higher specificity (92.8% vs 85.9%). MRI achieved a substantially higher cancer detection rate (16.5–22.7 per 1,000 women) compared with mammography (4.3–7.1 per 1,000 women) and was associated with a marked reduction in interval cancers. Although MRI showed higher recall and false-positive biopsy rates, these declined in subsequent screening rounds. Conclusion: In women with dense breast tissue, MRI provides superior sensitivity and cancer detection compared with mammography, albeit with higher false-positive rates. These findings support the integration of MRI into risk- and density-based breast cancer screening strategies to improve early detection and reduce interval cancers.

Background: Chikungunya virus (CHIKV), an arbovirus transmitted by Aedes aegypti and Aedes albopictus, has re-emerged as a major public health problem in India. Characterized by acute febrile illness with severe polyarthralgia, it can lead to chronic musculoskeletal complications. This study aimed to assess the seroprevalence and clinical profile of chikungunya infection among patients attending a tertiary care hospital in this region. Methodology: A cross-sectional study was conducted in the Department of Microbiology, Government Medical College, Kathua, from June 2023 to March 2024. A total of 539 clinically suspected cases, identified per WHO criteria, were tested for anti-CHIKV IgM antibodies using enzyme-linked immunosorbent assay (ELISA). Demographic and clinical data were analyzed using Pearson’s chi-square test, with p < 0.05 considered statistically significant. Results: Of the 539 samples, 96 were positive for chikungunya IgM antibodies, yielding a seroprevalence of 17.81%. Females (18.48%) were marginally more affected than males (16.74%), though without statistical significance. The highest positivity was observed among individuals aged >56 years (31.25%) and those from rural areas (29.69%) compared to urban residents (9.03%). The most common symptoms included abrupt-onset fever (89.8%), body pain (78%), and polyarthralgia (75.8%), with 48.2% of positive cases developing chronic arthritis. Conclusion: This study confirms significant chikungunya activity in the Kathua district, particularly in rural areas. Strengthening vector control measures, enhancing diagnostic surveillance, and increasing public awareness are essential to reduce transmission and mitigate long-term morbidity associated with chikungunya infection.

Background: Urinary tract infections (UTIs) are common during pregnancy and can lead to serious maternal and neonatal complications such as preterm labor and low birth weight. Physiological changes in pregnancy increase susceptibility to infection. Continuous monitoring of uropathogens and their antimicrobial resistance is essential to guide effective treatment and prevent resistant strain emergence. Materials and Methods: A retrospective cross-sectional study was conducted in the Department of Microbiology, Government Medical College, Kathua, from April 2023 to March 2025. A total of 560 midstream urine samples from pregnant women with suspected UTI were cultured using standard methods. Isolates were identified by biochemical tests, and antimicrobial susceptibility was determined using the Kirby–Bauer disk diffusion method following CLSI guidelines. Results: Out of 560 samples, 112 (20%) showed significant bacterial growth. Gram-negative bacilli accounted for 64.3% of isolates, with Escherichia coli (40.18%) being predominant, followed by Staphylococcus aureus (19.64%), coagulase-negative staphylococci (15.18%), Klebsiella spp. (12.5%), and Enterococci (8.93%). Nitrofurantoin was most effective against E. coli (80%), while S. aureus showed high sensitivity to cotrimoxazole (76%) and erythromycin (73%). Marked resistance to β-lactam antibiotics, particularly ampicillin and ceftriaxone, was noted. Conclusion: E. coli remains the predominant uropathogen in pregnant women, with increasing resistance to β-lactams. Nitrofurantoin, amikacin, and norfloxacin continue to be reliable treatment options. Routine culture-based diagnosis and antimicrobial surveillance are vital for effective management and resistance control.

Background: Osteoporosis and osteopenia are common, underdiagnosed conditions that significantly increase the risk of fragility fractures, morbidity, and mortality, particularly among the elderly and postmenopausal women. In India, data on bone health in apparently healthy adults remain limited, and early bone loss often goes undetected. Objectives: To determine the prevalence of osteopenia and osteoporosis among apparently healthy adults and to assess differences in bone mineral density (BMD) across age groups, gender, and elderly status. Methods: A retrospective cross-sectional study was conducted using data from routine bone health screening camps held between January 2018 and August 2019 in Cuttack, Odisha. A total of 1200 apparently healthy adults aged ≥18 years were evaluated. Bone mineral density was assessed using calcaneal quantitative ultrasound (QUS), and participants were classified as normal, osteopenic, or osteoporotic based on WHO T-score criteria. Participants were stratified into adults (18–59 years) and elderly (≥60 years), and gender-wise comparisons were performed. Data were analyzed using descriptive statistics and chi-square tests, with p < 0.05 considered statistically significant. Results: Among the 1200 participants, the mean age was approximately 48 years, with a nearly equal gender distribution. Overall, osteopenia was observed in about half of the participants, while osteoporosis was present in nearly one-fifth. The prevalence of osteoporosis was significantly higher among elderly participants compared to adults. Females showed a higher prevalence of osteoporosis than males, particularly among postmenopausal women. Osteopenia was more common in younger adults and males, indicating early bone loss before progression to osteoporosis. The differences in BMD distribution across age groups and gender were statistically significant. Discussion: The study highlights a substantial burden of bone loss even among apparently healthy adults. The high prevalence of osteopenia suggests that bone loss begins early and may progress silently to osteoporosis if left unaddressed. Elderly individuals and postmenopausal women remain the most vulnerable groups. These findings emphasize the need for early screening and preventive strategies. Conclusion: Osteopenia and osteoporosis are highly prevalent among apparently healthy adults. Routine screening using simple, non-invasive tools such as calcaneal QUS can aid in early detection of bone loss. Preventive interventions targeting younger adults, elderly individuals, and women may help reduce future fracture risk and associated morbidity.

Background: Diabetes mellitus (DM) and hypertension (HTN) are highly prevalent chronic non-communicable diseases and major contributors to cardiovascular morbidity and mortality. Their frequent coexistence increases the risk of complications such as cerebrovascular accident, chronic kidney disease, and myocardial infarction. Medication adherence plays a crucial role in effective disease control and prevention of complications. Objectives: To determine the prevalence of diabetes mellitus and hypertension among hospitalized patients, assess associated comorbidities and complications, evaluate medication adherence using the Morisky Medication Adherence Scale-4 (MMAS-4), and analyze the influence of age and gender. Methods: A prospective cross-sectional observational study was conducted over seven months in a tertiary care hospital in Koraput district of Odisha. A total of 320 hospitalized patients aged ≥14 years were included. Data on sociodemographic characteristics, medical history, comorbidities, complications, prescribed medications, and medication adherence were collected using patient records and MMAS-4 questionnaires. Descriptive analysis was performed using Microsoft Excel. Results: Among the 320 participants, 163 (50.9%) had a past medical history of chronic illness. Hypertension was observed in 88 (54.0%) patients, diabetes mellitus in 47 (28.8%), and both conditions in a substantial proportion. Disease-related complications were identified in 54 (33.1%) patients, with the highest burden seen among those with coexisting DM and HTN (71.2%). Medication adherence assessment revealed high adherence in 44 (27.0%) patients, medium adherence in 59 (36.2%), and low adherence in 41 (25.2%). Complications were more common among patients with low adherence. The mean age of patients with DM and HTN was 55 years, with no significant gender difference observed. Amlodipine, telmisartan-based combinations, metformin, and insulin were the most frequently prescribed medications. Conclusion: The study highlights a high prevalence of hypertension and diabetes mellitus among hospitalized patients, with a substantial burden of complications. Although medication adherence was generally satisfactory, poor adherence was associated with increased complications. Strengthening patient education, regular counseling, and adherence monitoring may help reduce disease progression and improve clinical outcomes.

Background:Adolescence is a critical developmental period marked by rapid physical, psychological, and reproductive changes. Adolescent girls are particularly vulnerable to nutritional deficiencies, menstrual disorders, and psychosocial problems, which may have long-term consequences on their health and future reproductive outcomes. Despite this, limited data are available on the health and nutritional status of adolescent girls in eastern India. Methodology: A hospital-based cross-sectional study was conducted among 350 school-going adolescent girls aged 10–17 years attending the Paediatric Outpatient Department and wards of MKCG Medical College and Hospital, Berhampur, Odisha, from November 2019 to November 2020. Data were collected using a pre-designed structured proforma, followed by clinical examination and anthropometric measurements. Nutritional status was assessed using Body Mass Index (BMI) and classified according to Revised Indian Academy of Pediatrics (IAP) 2015 BMI growth charts. Data were analyzed using R statistical software, and appropriate descriptive and inferential statistics were applied. Results: The mean age of participants was 13.1 ± 1.7 years. Approximately 62% of adolescents had normal nutritional status, while 38% were malnourished. Undernutrition was observed in about 25%, overweight in 9%, and obesity in 4% of participants. Pallor was present in nearly 19% of adolescents. About 71% had attained menarche, with a mean age of 13.2 ± 0.1 years. Dysmenorrhea was reported by 28.6%, and menstrual irregularities were common. Refractive errors were seen in 25%, while psychological problems were reported by a small proportion. A significant association was found between nutritional status and socioeconomic status, maternal occupation, family type, and dietary pattern (p < 0.05). Discussion: The study highlights a considerable burden of malnutrition and menstrual health problems among adolescent girls. The coexistence of undernutrition and overweight indicates a dual burden of malnutrition. Socioeconomic disadvantage and family-related factors played a significant role in influencing nutritional status, emphasizing the importance of addressing social determinants of adolescent health. Conclusion: Adolescent girls attending a tertiary care hospital in eastern India exhibited a high prevalence of nutritional and health-related problems. Strengthening adolescent-friendly health services, nutritional interventions, and health education programs is essential. Community-based studies with larger sample sizes are recommended to better understand and address adolescent health challenges.

Background: Depression is increasingly recognized as a significant comorbidity among patients with chronic diabetes mellitus, adversely affecting glycemic control, treatment adherence, and quality of life. Objectives: To evaluate the prevalence and severity of depression among patients with chronic diabetes and to analyze associated sociodemographic and clinical factors. Methods: A cross-sectional observational study was conducted among adult patients with diabetes of ≥5 years duration attending a tertiary care hospital. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Glycemic status, diabetes-related complications, and treatment variables were documented. Results: Among 240 participants, 38.3% exhibited depressive symptoms. Moderate-to-severe depression was significantly associated with poor glycemic control, longer disease duration, insulin therapy, and presence of microvascular complications (p < 0.05). Conclusion: Depression is highly prevalent among patients with chronic diabetes and is strongly linked to adverse clinical parameters. Routine mental health screening should be integrated into diabetes care pathways.

Background: Accurate implant positioning is critical in full-mouth implant rehabilitation to ensure biomechanical stability, prosthetic accuracy, and long-term clinical success. Digital workflows such as static surgical guides and dynamic navigation systems have been developed to improve placement precision, with recent integration of artificial intelligence (AI) further enhancing real-time decision-making. Aim: To compare the accuracy of implant placement in full-mouth rehabilitation using static surgical guides, dynamic navigation, and AI-assisted dynamic navigation systems. Materials and Methods: A prospective comparative study was conducted on 60 edentulous or partially edentulous patients requiring full-mouth implant rehabilitation. Patients were allocated into three groups (n = 20 per group): static guided surgery, dynamic navigation, and AI-assisted dynamic navigation. A total of 360 implants were placed. Postoperative CBCT scans were superimposed on preoperative plans to assess coronal deviation, apical deviation, and angular deviation. Statistical analysis was performed using one-way ANOVA with post-hoc Tukey tests. Results: Mean coronal deviation was highest in the static guide group (1.32 ± 0.34 mm) and lowest in the AI-assisted navigation group (0.62 ± 0.18 mm). Angular deviation showed a significant reduction from static guides (4.8° ± 1.2°) to AI-assisted navigation (2.1° ± 0.6°) (p < 0.001). Dynamic navigation demonstrated intermediate accuracy. Surgical time decreased significantly with AI assistance. Conclusion: AI-assisted dynamic navigation significantly improves implant placement accuracy in full-mouth rehabilitation compared to static and conventional dynamic systems. The incorporation of AI enhances real-time precision and reduces cumulative errors, supporting its growing role in advanced implant dentistry.

Abstract Aim: To investigate the correlation between periodontitis and rheumatoid arthritis (RA), and to evaluate periodontitis (PA) as a potential contributor for the development and progression of RA and generate model between RA and PA. Materials and Methods: A matched case-control analysis was conducted with 170 patients diagnosed with RA (case group) and 170 non-RA individuals (control group), all recruited from the same cohort. The matching of cases and controls was done at a one to one ratio based on age, gender, socioeconomic status. Random sampling method was employed. The periodontal status of participants were assessed following the 2017 World Workshop criteria for Classifying Periodontal and Peri-Implant Diseases and Conditions. Diagnosis of RA and assessment of its severity was measured using the Disease Activity Score (DAS-28). Statistical analysis included multivariate logistic regression, odds ratio (OR) estimation, and significance testing with a confidence interval of 95%. Result: The RA group exhibited significantly higher periodontal parameters—probing pocket depth (PPD) and clinical attachment loss (CAL)—and systemic inflammation, indicated by elevated erythrocyte sedimentation rate (ESR) values (p < 0.05). Mild periodontitis was more prevalent in the RA group (39.4%) than among controls (29.4%), with adjusted odds ratios ranging between 4.1 and 4.5. Binary logistic regression identified age, DAS-28 score, and ESR as significant predictors of RA, while educational status exerted a protective effect. Rheumatoid disease activity (DAS-28) correlated positively with the severity of periodontitis, with higher activity levels noted in patients with moderate to severe periodontal disease (p = 0.004). Overall, individuals with periodontitis had nearly threefold increased odds of RA (OR = 2.986; 95% CI: 1.871–4.765; p < 0.05). The association remained statistically strong after adjustment. Conclusion: The findings demonstrates a significant link between periodontitis and RA. Individuals with periodontitis demonstrated a higher risk of developing RA, and RA patients with co-existing periodontitis, tends to have more severe disease activity.

Background: A significant proportion of gastric cancer patients in India present at an advanced stage with associated gastric outlet obstruction, cancer cachexia and other complications. This in turn adversely affects their ability to undergo multimodality treatment effectively. Ever since the MAGIC trial demonstrated the efficacy of perioperative chemotherapy, there has been much interest in using neo-adjuvant chemotherapy for the treatment of gastric cancer. There are not yet much Indian studies published regarding the safety and efficacy of neo-adjuvant chemotherapy for carcinoma stomach. Our study was performed as a Retrospective institutional audit to compare the outcomes of the patients with gastric cancer who underwent upfront surgery with those who underwent surgery after neo-adjuvant chemotherapy.All patients who underwent curative Radical Gastrectomy for carcinoma stomach either upfront (or) after neo-adjuvant chemotherapy with treatment policy taken in the multi-disciplinary tumour board were included in the audit.After Neo-adjuvant chemotherapy followed by surgery, the post-operative HPE reports tend to be at a lower stage than those in patients undergoing upfront surgery. This proves the role of chemotherapy in downstaging the disease. EOX regimen tends to offer better survival than ECF regime, though subgroup analysis has not been done. When compared, patients who underwent surgery after Neo-Adjuvant Chemotherapy tend to do well with an increased Overall Survival (OS) than patients who underwent upfront surgery.This implies that Neo-adjuvant Chemotherapy before surgery offers a survival advantage to carcinoma stomach patients, probably due to earlier targeting of micro-metastases.Neo-Adjuvant chemotherapy for all cases of gastric adenocarcinoma except Early Gastric Cancer, offers the potential for improved survival after surgery, especially in the Indian population

Background: Laparoscopic appendectomy is the preferred surgical approach for acute appendicitis. However, complicated cases may necessitate conversion to open surgery, increasing patient morbidity and healthcare costs. Objective: To determine whether pre-operative appendix diameter on imaging can predict conversion to open surgery during laparoscopic appendectomy. Methods: A prospective observational study was conducted at a tertiary care center in Belagavi, Karnataka, from September 2022 to August 2023. Sixty-three adult patients undergoing laparoscopic appendectomy were included. Appendix diameter was measured using ultrasonography (USG) or contrast-enhanced computed tomography (CT). The rate and reasons for conversion to open surgery were recorded and analysed using ROC curves. Results: Of the 63 patients, 7 (11.1%) required conversion to open surgery. ROC curve analysis identified an appendix diameter of 8.95 mm as the optimal cutoff for predicting conversion (sensitivity 71.4%, 1-specificity 33.9%). Cases with diameters >8.95 mm had significantly higher conversion rates due to reasons including anatomical difficulty, abscess formation, and perforation. Conclusion: Pre-operative appendix diameter >8.95 mm is associated with a higher risk of conversion to open surgery. This parameter can assist surgeons in pre-operative planning and patient counselling.

Background: Neonatal sepsis remains a leading cause of neonatal morbidity and mortality, particularly in developing countries. Early diagnosis is challenging due to nonspecific clinical manifestations and the limited sensitivity of blood culture, which is considered the diagnostic gold standard. Identification of reliable early predictive markers is essential to facilitate timely diagnosis, optimize antibiotic therapy, and improve clinical outcomes. Objectives: To evaluate early predictive markers of neonatal sepsis and to assess their association with culture-proven sepsis and short-term clinical outcomes in neonates admitted to a tertiary care center. Materials and Methods: This prospective observational study was conducted over a period of 15 months at a tertiary care center in India. A total of 120 neonates with clinical suspicion of sepsis were enrolled consecutively. Detailed demographic and clinical data were recorded. Blood culture and hematological and biochemical markers, including total leukocyte count, absolute neutrophil count, immature-to-total neutrophil ratio, platelet count, and C-reactive protein, were evaluated at presentation. Neonates were followed until discharge or death, and outcomes were documented. Statistical analysis was performed to assess the association between early predictive markers, culture positivity, and clinical outcomes. Results: Male neonates constituted 60% of the study population. Early-onset sepsis was observed in 61.7% of cases. Blood culture positivity was documented in 36.7% of neonates. Elevated C-reactive protein, abnormal immature-to-total neutrophil ratio, thrombocytopenia, and abnormal absolute neutrophil count showed a significant association with culture-positive sepsis and unfavorable outcomes. The majority of neonates (81.7%) recovered and were discharged, while 11.7% required prolonged NICU stay and the overall mortality rate was 6.6%. Conclusion: Early predictive markers such as C-reactive protein, immature-to-total neutrophil ratio, and platelet count are valuable adjuncts to blood culture in the early diagnosis and prognostication of neonatal sepsis. Their routine use, in combination with clinical assessment, can facilitate timely management, reduce diagnostic uncertainty, and improve neonatal outcomes, especially in resource-limited settings.

Introduction: Superficial mycoses include superficial fungal infections of the skin, hair, and nail (onychomycosis). It is caused by dermatophytes, yeasts (e.g., Candida, Malassezia), and non-dermatophyte molds. Amongst these, dermatophytes are responsible for the highest proportion of cases.[1] Dermatophytes are classified under three asexual genera, namely Trichophyton, Epidermophyton, and Microsporum.[1] . The microscopic examination is generally done by KOH and calcofluor white fluorescent stain. The calcofluor white stain is very sensitive technique which helps in the identification of fungal elements, even in small quantities and less experience of the observer. Objectives: 1.To compare the sensitivity and specificity of direct microscopic examination by KOH, CFW stain and fungal culture. 2. To study the microbiological profile causing superficial mycosis. Materials and methods: Place of study: Department of Microbiology, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram. Duration of study: October 2024 to November 2025. Inclusion criteria: All patients with superficial mycosis are included. KOH, CFW and Fungal culture were done. Results: Total 100 samples were processed and among them 76% are positive with KOH, 84% positive with CFW and 78% positive with fungal culture. Among the fungal cultures 44% are dermatophytes which includes Trychophyton rubrum 30.7%, Trychophyton mentagrophytes 23%, Microsporum gypseum 2.5%. Non dermatophytes include Aspergillus 19.2%, Penicillium spp 5.1%, Fusarium 2.5%. Yeasts include Candida albicans 8.9% and Candida nonalbicans 7.6%.CFW study showed high sensitivity and specificity with positivity 84%, fungal culture showed 78% positivity and KOH showed 76% positivity. Conclusion: Superficial mycosis is the commonest fungal infection occurring more commonly in diabetes and immunocompromised patients. It is necessary to have early and appropriate diagnosis in treatment of fungal infection. CFW is showing a higher positivity rate

Background: CT enterography (CTE) has emerged as a reliable, non-invasive imaging modality for evaluating small bowel diseases, with the advantage of combining bowel distension assessment with mural and extra-enteric evaluation. Neutral oral contrast agents such as mannitol are increasingly used for their availability, cost-effectiveness, and good patient tolerability. Aim: To assess the distending ability of mannitol as oral contrast agent for assessment of small bowel by evaluating the mean distensibility score in 70 patients. Methods: A total of 70 patients were studied, including 30 controls and 40 patients with proven or suspected small bowel disease. Mannitol was used as the oral contrast agent in all cases. Parameters analyzed included luminal distension (graded and scored), bowel caliber and wall thickness, patient acceptance and side effects, mural enhancement patterns, degree and length of involvement, small bowel obstruction, and mesenteric changes (fat, vessels, lymph nodes). Results: In the control group, optimal/good luminal distension was achieved in 83% of duodena, 100% of jejuna, and 66.6% of ilea. Mean bowel caliber ranged from 2.4–2.8 cm, and mean wall thickness was <3 mm across all segments. Mannitol was well tolerated in 93.3% of patients, with minor side effects (nausea, vomiting, diarrhea) in 50%. In the pathology group (n=40), the most common conditions were inflammatory bowel disease (35%), small bowel tumors (25%), and tuberculosis (12.5%). Tumors most frequently showed marked wall thickening (>10 mm) and target-type enhancement, while tuberculosis typically affected the ileocecal region with homogenous mural enhancement and associated lymphadenopathy. IBD demonstrated segmental/diffuse involvement with mixed enhancement patterns. Obstruction was most often caused by tumors, intussusception, and volvulus. Mesenteric fat stranding was present in 70% of pathological cases, vascular involvement in 27.5%, and lymphadenopathy in 52.5%. Conclusion: Mannitol is a safe, effective, and well-tolerated oral contrast agent for CTE, providing satisfactory bowel distension and patient compliance. CTE reliably characterizes mural, luminal, and mesenteric features of diverse small bowel diseases, with findings consistent with contemporary literature. It is particularly useful in differentiating neoplastic, inflammatory, and infectious conditions, as well as in detecting complications such as obstruction and mesenteric involvement.

Background: Adnexal masses are frequently encountered in women of reproductive age and present a diagnostic challenge due to their varied etiology and the need to preserve fertility. While ultrasonography and tumor markers aid in initial evaluation, laparoscopy offers direct visualization and simultaneous therapeutic intervention. This study was undertaken to assess the role of laparoscopy in the evaluation and management of adnexal masses in women of reproductive age. Objectives: To evaluate the diagnostic accuracy and therapeutic effectiveness of laparoscopy in adnexal masses among women aged 18–40 years and to analyze clinical presentation, laparoscopic findings, histopathological outcomes, and perioperative complications. Methods: This cross-sectional study was conducted in the Department of Obstetrics and Gynecology at Prathima Institute of Medical Sciences, Karimnagar. A total of 56 women aged 18–40 years with clinically and ultrasonographically suspected adnexal masses were included. Patients with large masses (>12 cm), suspicious ultrasonographic features, elevated CA-125 levels, pregnancy, or contraindications to laparoscopy were excluded. All patients underwent detailed clinical evaluation, ultrasonography, serum CA-125 estimation, and laparoscopic evaluation under general anesthesia. Therapeutic procedures were performed as indicated, and excised specimens were subjected to histopathological examination. Results: Abdominal pain was the most common presenting symptom (36%). Ultrasonography most frequently revealed ovarian cysts (36%), followed by torsion ovarian cysts and polycystic ovarian disease (18% each). Laparoscopy identified ovarian cysts in 24% of cases, adhesions in 20%, and free fluid in the pouch of Douglas in 24%. Functional ovarian cysts constituted the most common histopathological diagnosis (42%). Cystectomy was the most commonly performed procedure (32%). Conversion to laparotomy was required in 4% of cases. Intraoperative and postoperative complications were minimal, with no major morbidity. Conclusion: Laparoscopy is a safe, effective, and fertility-preserving modality for the evaluation and management of adnexal masses in women of reproductive age. With careful patient selection, it provides accurate diagnosis, enables definitive treatment in a single sitting, and is associated with low complication rates and rapid recovery.

Background: Transverse abdominis plane block is generally given for post operative pain relief in patients for inguinal hernia surgeries. Recently Erector spinae plane block is gaining popularity for postoperative pain management. Aim: To compare the effectiveness of TAP and ESPB in providing post- operative analgesia for inguinal hernioplasty. Materials and methods: The study was a Prospective Randomized comparative study. 60 patients scheduled for elective open inguinal hernioplasty under spinal anesthesia were randomly assigned to two groups. Group 1 ( n=30) : received USG guided Transverse abdominis plane block with 20 ml of 0.25% bupivacaine . Group 2 (n=30) : patients received USG guided Lumbar Erector spinae plane blocks with 20 ml of 0.25 % bupivacaine. Post operative analgesia using NRS score , time for first rescue analgesia and total amount of analgesics consumption were recorded . Results: ESP block provided prolonged analgesia compared to the TAP block, and the mean time to first rescue analgesia was more in ESPB ( 5.1 ± 1.9 hours) when compared to TAP ( 4.2 ± 1.8 hours ) which is statiscally significant (P <0.05). The requirement of total analgesic was also significantly less in the ESP group compared to the TAP group (P < 0.05). Conclusions: USG guided Lumbar Erector spinae plane block has better post operative analgesia when compared to USG guided TAP block for open inguinal hernioplasty. The time to first rescue analgesia was more in ESPB Group when compared to TAP Group. The total rescue analgesia requirement was less in ESP block when compared to TAP block.

BACKGROUND – We investigated whether alveolar recruitment strategy followed by decremental PEEP trial improves oxygenation, and ventilation during one lung ventilation in thoracic surgeries. METHODS – Fifty patients undergoing different thoracic surgeries in lateral decubitus position, we studied the gas exchange by serial ABG and hemodynamics after alveolar recruitment maneuver with decremental PEEP titration. RESULTS – The optimum PEEP was found to be 5-7 cmh2o on which PaO2 was highest and so was the P/F ratio as FiO2 was kept constant i.e. 0.8 throughout the surgery. The mean PaO2 levels displayed Variability across the different peep levels with PEEP 5cm H2O demonstrating the highest mean Pao2 (311.6 mmHg). Statistical analysis indicated substantial differences (f-VALUE =4.876, P VALUE =0.0002), affirming the strong association between PEEP levels and MAP.CONCLUSIONS – The decremental PEEP strategy after lung recruitment improved significant effects in oxygenation during OLV.

Background: Respectful maternity care (RMC) emphasizes dignity, privacy, and women’s rights during childbirth. This study evaluates maternal satisfaction and adherence to RMC practices at HIMS, Varanasi, focusing on its impact on care quality. Methods: This cross-sectional study was conducted over 18 months at HIMS, Varanasi, with ethical approval. Informed consent was obtained from 1488 participants. Data were collected using structured questionnaires, and statistical analysis was performed using IBM-SPSS version 23.0. Mean, standard deviation (SD), and interquartile range (IQR) with 95% confidence intervals (CI) were calculated. Results: The mean age of participants was 24.9±3.1 years. Most were from rural areas (65.8%) and lower socioeconomic groups (44.82%). Satisfaction was highest for registration (mean score: 3.53±0.8) and meal provision (mean score: 3.27±0.7). Breastfeeding initiation (mean score: 2.53±1.2) and support services (mean score: 3.13±0.9) required improvement. P-values for satisfaction differences were significant (<0.05). Conclusion: The LaQshya Programme improved maternal satisfaction, particularly for registration and meal services. However, timely breastfeeding initiation and support services require focused efforts.

Neoadjuvant chemotherapy is increasingly used in the management of gynecologic cancers to improve surgical feasibility in patients with advanced or bulky disease. Pathological complete response has been proposed as a marker of treatment efficacy; however, its frequency and prognostic relevance across gynecologic malignancies remain incompletely defined. A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines, with a comprehensive search of PubMed/MEDLINE, Embase, Scopus, and Cochrane CENTRAL from inception to December 2024. Studies reporting pathological response following neoadjuvant chemotherapy in ovarian, cervical, or endometrial cancers were included. Twelve studies comprising 2,184 patients were identified, with ten eligible for quantitative synthesis. The pooled pathological complete response rate was 16.2%, with substantial variation by cancer type, being highest in cervical cancer (29.1%), followed by endometrial cancer (19.4%) and ovarian cancer (9.3%). Achievement of pathological complete response was associated with significantly improved overall survival (hazard ratio 0.45) and progression-free survival (hazard ratio 0.41) compared with residual disease. Moderate heterogeneity was observed across analyses. These findings indicate that pathological complete response, although infrequent, is a strong prognostic marker in gynecologic cancers. Standardized pathological definitions and prospective validation are required before pathological complete response can be reliably adopted as a surrogate endpoint or integrated into routine clinical decision-making.

Background: Vitamin B12 deficiency is a common health problem worldwide. The prevalence of vitamin B12 deficiency in north Indian population is almost 47 %. There are limited data on vitamin B12 status in Indian rural population. Aim: to estimate the prevalence of vitamin B12 deficiency in this population. Methods: This was a cross sectional study conducted in 427 participants selected by stratified random sampling from rural areas of Bikaner district from December 2023 to May 2024. Demographic and other data were collected by interviewing the participants with a predesigned questionnaire and 3 ml venous blood sample was collected and analyzed for serum B12 levels. Results: were tabulated in Microsoft Office Excel worksheet and statistical analysis was performed by using SPSS Statistical Software version 21.0. Level of statistical significance was taken as p value <0.05. Results: The study involved 427 participants (M: F ratio 3:4, mean age 36.86 + 17.42 years) with 32.08% of them had vitamin B12 deficiency (mean B12 level 199.08 + 88.09 pg/ml). The severity of deficiency included borderline (18.73%), mild (2.34%), moderate (5.85%), and severe (5.15%). Deficiency in different demographics like in male (27.81%), female (35.42%), in age group of 21-40 years (42.34%) and 41.67% among elderly were deficient. 81.75% of deficiency participants were vegetarian (P value <0.0001). Conclusions: This study provides critical data on vitamin B12 deficiency prevalence and its associated factors, which will help in developing effective prevention and management strategies, including targeted food fortification for the Indian population.

Background: Diabetic retinopathy is traditionally considered a complication of established diabetes mellitus; however, emerging evidence suggests that retinal microvascular changes may begin during the prediabetic stage. Identifying retinopathy and its associated risk factors in individuals with prediabetes may allow earlier intervention and prevention of disease progression. Objectives: To determine the frequency and types of retinopathy in individuals with prediabetes and to assess its association with demographic, clinical, and biochemical risk factors. Methods This hospital-based prospective observational study was conducted in the Department of Ophthalmology at a tertiary care center in North India from April 2023 to March 2024. Seventy-five adults with prediabetes, defined according to American Diabetes Association criteria, were enrolled. All participants underwent detailed clinical evaluation, biochemical investigations, and comprehensive ophthalmological examination, including fundus evaluation and grading of retinopathy using the ETDRS classification. Associations between retinopathy and risk factors were analyzed using appropriate statistical tests, with a p-value <0.05 considered statistically significant. Results: Retinopathy was detected in 8 out of 75 participants (10.7%). The presence of retinopathy was significantly associated with advancing age (p = 0.028), higher systolic blood pressure (p = 0.047), higher diastolic blood pressure (p = 0.034), deranged renal function (p < 0.001), elevated total cholesterol (p = 0.031), elevated triglycerides (p = 0.027), elevated LDL cholesterol (p = 0.008), and reduced HDL cholesterol (p = 0.017). No significant association was observed with sex, body mass index, smoking status, or family history of diabetes mellitus. Conclusion: Retinopathy was present in a substantial proportion of individuals with prediabetes and was significantly associated with modifiable cardiometabolic risk factors, particularly hypertension, renal dysfunction, and dyslipidemia. These findings highlight the need for early ophthalmic screening and aggressive management of cardiovascular risk factors in prediabetic individuals to prevent progression of retinal microvascular disease.

Background: The global rise in adolescent overweight and obesity has been accompanied by an increasing burden of hypertension, much of which remains undiagnosed due to its asymptomatic nature and inconsistent screening practices. Simple cuff-based blood pressure (BP) measurement is widely accessible and commonly used for initial detection, particularly in resource-limited and school-based settings. This systematic review and meta-analysis aimed to estimate the prevalence of undiagnosed hypertension among overweight and obese adolescents identified using cuff-based BP measurement. Methods: A systematic search of PubMed/MEDLINE, Scopus, Embase, and Google Scholar was conducted from database inception to June 2025. Observational studies reporting prevalence of hypertension among overweight and/or obese adolescents detected using office or screening BP measurement were included. Study selection, data extraction, and risk-of-bias assessment (Joanna Briggs Institute checklist) were performed independently by two reviewers. Random-effects meta-analysis was planned; heterogeneity was assessed using the I² statistic. Results: Two studies met the inclusion criteria, encompassing school-based and health-system–based settings. The prevalence of undiagnosed hypertension among overweight adolescents ranged from 2.0% to 34.0%, while prevalence among obese adolescents ranged from 5.6% to 46.7%. Both studies demonstrated a clear increase in hypertension prevalence with rising BMI category. Extreme heterogeneity (I² >90%) precluded reliable pooled prevalence estimates. Conclusions: A substantial proportion of overweight and obese adolescents have undiagnosed hypertension detectable using simple BP cuffs, with consistently higher prevalence among obese individuals. Although prevalence estimates vary widely across settings, these findings support targeted blood pressure screening in adolescents with excess weight, using standardized measurement and confirmation strategies to enable early cardiovascular risk reduction.

Background: Primary Open-Angle Glaucoma (POAG) and hypothyroidism are both common chronic conditions that can significantly affect quality of life. While both diseases are individually prevalent in India, their potential association remains underexplored, especially in the Indian population. Aim: To investigate ophthalmologic findings in patients with hypothyroidism and determine the hospital-based prevalence of Primary Open-Angle Glaucoma (POAG) among them. Methods: This hospital-based, cross-sectional observational study was conducted over 18 months at the Department of Ophthalmology, Maharishi Markandeshwar Medical College and Hospital, Solan. Eighty hypothyroid patients aged ≥40 years were enrolled using convenience sampling. Diagnosis of hypothyroidism was based on elevated TSH (>4.20 µIU/mL) with normal or low T3 and T4 levels. Participants underwent detailed ophthalmologic evaluation including intraocular pressure measurement, gonioscopy, fundus examination, and perimetry. Results: Of the 80 hypothyroid patients, 9 (11.25%) were diagnosed with POAG. The majority of POAG cases were female (88.9%) and overweight or obese (100%). Visual field defects were significantly more frequent in POAG patients compared to those with normal IOP (p < 0.001). Optic nerve damage was seen in 77.8% of POAG cases. Patients with POAG had significantly higher TSH (14.4 ± 2.87 µIU/mL) and lower T3 levels (71.4 ± 31 ng/dL) than those without POAG (p = 0.0036 and p = 0.0116, respectively). Conclusion: This study found a notable prevalence of POAG among hypothyroid patients, suggesting a possible association between elevated TSH levels and glaucomatous changes. Routine ophthalmologic screening may be beneficial in the early detection of POAG in patients with hypothyroidism, especially in high-risk groups.

Neoadjuvant chemotherapy (NACT) is increasingly incorporated into the management of selected gynecologic cancers, yet the clinical relevance of pathological complete response (pCR) remains uncertain. In this systematic review and meta-analysis, we synthesized available evidence to define pooled pCR rates and examine their prognostic significance following NACT. Across 28 studies comprising 1,842 patients, pCR was achieved in 16.4% of cases, with higher rates observed in ovarian cancer compared with cervical and endometrial malignancies. Platinum-taxane-based regimens were associated with improved pCR rates. Importantly, achievement of pCR correlated with significantly improved overall and progression-free survival. Despite substantial inter-study heterogeneity and variability in pathological definitions, these findings support pCR as a potentially meaningful endpoint in gynecologic oncology. Prospective studies employing standardized pathological criteria are required to validate pCR as a surrogate marker of long-term outcomes and to optimize neoadjuvant treatment strategies.

Background: Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Effective secondary prevention through guideline-based control of modifiable risk factors including lifestyle modification, pharmacological therapy, and metabolic control significantly reduces the risk of recurrent cardiovascular events. However, real-world adherence to comprehensive secondary prevention strategies is often suboptimal, particularly in low- and middle-income countries. Evaluating the extent of risk-factor control and identifying barriers to optimal adherence are essential for improving long-term outcomes in post-MI patients. Aims and Objectives: The present study aimed to estimate the level of control of secondary prevention risk factors among follow-up patients of myocardial infarction and to identify the reasons for inadequate risk-factor control, if any.Materials and Methods: This descriptive cross-sectional study included 150 follow-up patients with a history of myocardial infarction attending a tertiary care centre. Data were collected on demographic characteristics, lifestyle behaviours, dietary practices, medication adherence, physical activity, anthropometric indices, blood pressure, glycaemic status, preventive practices, and overall composite risk-factor control. Associations between risk-factor control and demographic variables were analysed using the chi-square test, with a p-value <0.05 considered statistically significant. Results: Adherence to individual secondary prevention measures was satisfactory for pharmacological therapy, including beta-blockers (88.00%), ACE inhibitors (86.67%), statins (82.00%), and antiplatelet agents (81.33%). Glycaemic control was achieved in 86.67% of patients, and blood pressure was controlled in 72.67%. However, lifestyle-related measures showed poorer adherence, particularly physical activity (39.33%) and BMI control (58.00%), while influenza vaccination uptake was extremely low (7.33%). Overall good control of all secondary prevention risk factors was observed in only 8 patients (5.33%), with the remaining 94.67% demonstrating poor composite control. No statistically significant association was found between overall risk-factor control and age, sex, socio-economic status, locality, religion, or time since MI (p > 0.05). The most common reasons for inadequate control included medication non-compliance (26.47%), financial constraints (22.35%), lack of awareness (18.82%), and irregular follow-up (16.47%).Conclusions: Despite satisfactory adherence to several individual components of secondary prevention, comprehensive guideline-based control of all risk factors was achieved in only a small proportion of post-MI patients. Poor overall control was widespread across all demographic subgroups and was driven by multifactorial patient- and system-related barriers. These findings highlight the need for integrated, patient-centred, and system-level strategies to improve comprehensive secondary prevention and reduce recurrent cardiovascular risk.

Background: Congenital hypothyroidism (CH) is a common and preventable cause of intellectual disability if not detected and treated early. Umbilical cord blood thyroid profiling offers a practical alternative to postnatal screening, particularly in resource-limited settings where follow-up may be challenging. This study aimed to estimate the proportion of congenital hypothyroidism among newborns delivered at a tertiary care hospital in Gujarat using cord blood thyroid parameters. Methods: A prospective observational study was conducted over nine months at Sir T. Hospital, Bhavnagar. Cord blood samples from 509 live-born neonates were collected immediately after birth and analyzed for thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4) using standardized immunoassay techniques. Neonates with cord blood TSH levels >11.5 mIU/L and/or low free T3 or free T4 were recalled for confirmatory venous testing at 72 hours of life. Demographic and perinatal variables were recorded, and statistical analysis was performed using SPSS version 29. Results: The mean cord blood TSH level was 6.29 ± 2.15 mIU/L. Mean free T3 and free T4 levels were 1.53 ± 0.31 pg/mL and 1.42 ± 0.18 ng/dL, respectively. One neonate (0.2%) had abnormal cord blood thyroid parameters and persistent elevation of venous TSH (34 mIU/L) with low free T3 and free T4 at 72 hours, confirming congenital hypothyroidism. No significant association was observed between cord blood thyroid levels and gender, gestational age, or mode of delivery (p > 0.05). Conclusion: The incidence of congenital hypothyroidism in this cohort was 1 in 509 live births. Cord blood thyroid screening proved to be a feasible and effective method for early detection of CH and may serve as a valuable screening strategy in similar settings.

Background: Effective postoperative pain management is essential for enhanced recovery following lower abdominal surgeries. Ultrasound-guided transversus abdominis plane (TAP) block is a widely used regional analgesic technique, but the optimal local anesthetic agent remains a subject of debate. This study aimed to compare the analgesic efficacy of ropivacaine and bupivacaine when used in ultrasound-guided TAP block for postoperative analgesia. Methods: This prospective, randomized, double-blind trial included 100 patients of ASA physical status I and II, aged 18–65 years, undergoing elective lower abdominal surgeries. Patients were randomly allocated into two groups: Group R (n = 50) received ultrasound-guided TAP block with 20 mL of 0.5% ropivacaine, and Group B (n = 50) received 20 mL of 0.25% bupivacaine. Postoperative pain was assessed using the Numeric Rating Scale (NRS). The primary outcomes were duration of analgesia and postoperative pain scores. Secondary outcomes included total rescue analgesic consumption in the first 24 hours and patient satisfaction scores. Statistical analysis was performed using appropriate parametric and non-parametric tests, with p < 0.05 considered statistically significant. Results: The duration of analgesia was significantly longer in Group R compared to Group B (11.8 ± 2.4 vs. 8.3 ± 1.9 hours; p < 0.001). Mean NRS scores at 6 hours postoperatively were significantly lower in Group R (2.3 ± 0.8) than in Group B (3.6 ± 1.0; p < 0.001). The requirement for rescue analgesics within 24 hours was also significantly reduced in Group R (p < 0.001). Patient satisfaction scores were significantly higher in the ropivacaine group (p < 0.01). Conclusion: Ultrasound-guided TAP block with ropivacaine provides superior and longer-lasting postoperative analgesia, reduces analgesic requirements, and improves patient satisfaction compared to bupivacaine in elective lower abdominal surgeries.

Background: Osteoarthritis of the knee is a leading cause of pain and disability worldwide. Robotic‐assisted total knee arthroplasty (RA‐TKA) has emerged to enhance implant alignment, soft‐tissue balance, and functional recovery compared to conventional techniques. Objectives: To evaluate early functional outcomes and safety of RA‐TKA in patients with advanced knee osteoarthritis. Material and Methods: In this prospective study, 25 patients (30 knees) with Kellgren–Lawrence grade III–IV osteoarthritis underwent RA‐TKA using the CUVIS Joint™ system. Preoperative assessments included range of motion (ROM) and American Knee Society Score (AKSS). Postoperative evaluations were performed at one, three, and six months, recording ROM, AKSS, and any complications. Results: Mean age was 65 years; 52% were male. Preoperative mean ROM was 83.4°±5.4°, improving to 89.9°±6.5° at one month, 100.7°±5.3° at three months, and 116.3°±9.0° at six months (p<0.001). AKSS increased from 75.2±4.5 preoperatively to 80.5±5.1 at one month, 87.7±3.5 at three months, and 94.1±1.3 at six months (p<0.001). Only one patient (4%) experienced postoperative knee stiffness; no infections or revisions occurred. Conclusion: RA‐TKA yielded significant early improvements in knee mobility and clinical scores, with minimal complications. These findings support the precision and safety of robotic technology in optimizing early functional recovery in knee osteoarthritis.

Introduction: Bone marrow examination comprising bone marrow aspiration (BMA) and bone marrow biopsy (BMB) is a cornerstone in diagnosing a wide array of haematological conditions. In a tertiary care hospital, where referrals often involve complex or unclear cases, marrow evaluation provides decisive information that complements peripheral blood analysis, clinical findings, and other laboratory investigations. Bone marrow examination will give information about hemopoietic tissue in various conditions in addition to findings of blood sample as the bone marrow can be affected by both haematological and non-haematological disorders. Aim and objectives: This study is done to analyse bone marrow, as per age & sex and its distribution accordingly, to study as per clinical indications and findings, to study as per cellular morphology including cellularity, lineage distribution, maturation patterns, presence of abnormal or infiltrative cells and nature of pathology (neoplastic or non-neoplastic), to study and compare peripheral blood smears and bone marrow aspiration findings, to study as per available special confirmatory tests. Methods: A cross-sectional descriptive study was conducted in the Central Clinical Laboratory, Department of Pathology, PDU Medical College & Hospital Rajkot, Gujarat, India within the period of September 2022 to July 2025. All patients undergoing bone marrow aspiration (with or without biopsy) during this period were included. Results: The study included 129 patients over the defined period from September 2022 to July 2025. • Age range and gender distribution: In the comparable audit, patients ranged from 1 month to 85 years; 56(43.41%) were male, 73(56.59%) were female. • Common clinical indications for bone marrow examination included:  Evaluation of anaemia  Pancytopenia (low counts in more than one lineage)  Suspected malignant disorders  Unexplained fever  Thrombocytopenia In both aspiration and biopsy, most common findings were megaloblastic anaemia 38(29.45%), normochromic normocytic anaemia 15(11.62 %), hypochromic microcytic anaemia 20(15.50%), dimorphic anaemia 25(19.37%), myeloproliferative disorder 8(6.20%) and lymphoproliferative disorder 5(3.87%). Conclusion: Bone marrow study is a diagnostic test procedure useful in evaluating haematological and non-haematological disorder. It helps uncover both malignant and non-malignant haematological disorders, guides clinical decision-making, and complements peripheral blood studies. The ultimate interpretation of bone marrow examination requires the integration of Peripheral blood smear, Bone Marrow Aspiration and trephine biopsy findings together with the results of supplementary tests such as biochemical tests, immunophenotyping, and molecular genetic studies as appropriate, in context of clinical and diagnostic findings.

Background: Breast lumps are a common clinical presentation and encompass a wide spectrum of benign and malignant conditions. Accurate clinicopathological evaluation is essential for timely diagnosis and appropriate management. Objectives: To study the clinical profile of patients presenting with breast lumps and to correlate clinical findings with cytological and histopathological diagnoses. Materials and Methods: This hospital-based observational study included 170 patients presenting with breast lumps at a tertiary care hospital. Detailed clinical evaluation was performed in all cases. Fine Needle Aspiration Cytology (FNAC) was carried out, and histopathological examination of excised specimens was considered the gold standard. Clinicopathological correlation was analyzed using descriptive statistics. Results: The majority of patients were young females, with the highest incidence observed in the 21–30 years age group. Benign lesions predominated, with fibroadenoma being the most common diagnosis. The upper outer quadrant was the most frequently involved site. FNAC showed a high degree of concordance with histopathological findings, confirming its diagnostic reliability. Conclusion: Most breast lumps are benign in nature. FNAC, when combined with clinical assessment, is an effective and reliable diagnostic tool. Clinicopathological correlation plays a vital role in the accurate diagnosis and management of breast lumps.

Background: Depth of myometrial invasion (DMI) is a key prognostic factor in endometrial cancer and plays a critical role in surgical planning and risk stratification. Magnetic resonance imaging (MRI) is widely used for preoperative assessment of myometrial invasion; however, reported diagnostic accuracy varies across studies. Purpose: To systematically evaluate and meta-analyze the diagnostic accuracy of MRI for assessing depth of myometrial invasion in endometrial cancer using histopathology as the reference standard. Methods: A systematic search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception to June 2025. Studies evaluating MRI for differentiating superficial (<50%) from deep (≥50%) myometrial invasion and reporting sufficient data to construct 2×2 contingency tables were included. Study quality was assessed using the QUADAS-2 tool. Pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) were calculated using a bivariate random-effects model. Hierarchical summary receiver operating characteristic (HSROC) analysis was performed, and publication bias was assessed using Deeks’ funnel plot. Results: Twenty-eight studies comprising approximately 4,200 patients were included. The pooled sensitivity of MRI for detecting deep myometrial invasion was 0.75 (95% CI: 0.70–0.80), and pooled specificity was 0.87 (95% CI: 0.83–0.91). The pooled positive likelihood ratio was 5.8, and the negative likelihood ratio was 0.29, yielding a diagnostic odds ratio of 20.0. The HSROC curve demonstrated an area under the curve (AUC) of 0.89, indicating good overall diagnostic accuracy. Subgroup analyses showed improved sensitivity with multimodal MRI protocols incorporating diffusion-weighted and dynamic contrast-enhanced imaging, and slightly higher specificity with 3-Tesla MRI systems. Deeks’ funnel plot did not indicate significant publication bias (P = 0.44). Conclusion: MRI demonstrates good diagnostic accuracy for preoperative assessment of deep myometrial invasion in endometrial cancer, with high specificity and moderate sensitivity. Use of advanced imaging sequences and higher field strength scanners enhances performance. MRI should remain central to preoperative staging, while clinicians should be aware of its limitations and interpret findings within the broader clinical context.

Background: Neoadjuvant chemotherapy (NACT) is increasingly used in the management of advanced gynecologic malignancies. Pathological complete response (pCR) after NACT has emerged as a potential surrogate marker of treatment efficacy; however, reported pCR rates and their prognostic significance in gynecologic cancers remain heterogeneous and incompletely defined. Objective:To systematically review and meta-analyze available evidence on pathological complete response following neoadjuvant chemotherapy in gynecologic cancers and to evaluate its association with survival outcomes. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, and Cochrane CENTRAL were searched from inception to January 2025. Studies reporting pCR after neoadjuvant chemotherapy in ovarian, cervical, or endometrial cancers were included. Random-effects meta-analyses were performed to estimate pooled pCR rates and hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS). Heterogeneity was assessed using the I² statistic, and risk of bias was evaluated using validated tools. Results: Twenty-three studies involving 4,216 patients met the inclusion criteria, with 18 studies eligible for quantitative synthesis. The pooled pathological complete response rate across all gynecologic cancers was 14.8% (95% CI: 11.9–17.9%). Subgroup analysis demonstrated the highest pCR rates in cervical cancer (27.4%), followed by endometrial cancer (18.6%) and ovarian cancer (8.9%). Achievement of pCR was significantly associated with improved overall survival (pooled HR: 0.42; 95% CI: 0.33–0.54) and progression-free survival (pooled HR: 0.39; 95% CI: 0.30–0.51). Moderate heterogeneity was observed across analyses. Conclusions: Pathological complete response following neoadjuvant chemotherapy, although uncommon, is strongly associated with favorable survival outcomes in gynecologic cancers. Variability in pCR rates across tumor types highlights differences in chemosensitivity and tumor biology. Standardized definitions of pCR and prospective validation are required before its routine use as a surrogate endpoint or clinical decision-making tool in gynecologic oncology.

Background: Screen exposure has become increasingly prevalent among school-going children, with many exceeding recommended usage limits. Growing evidence suggests that prolonged and late-evening screen use may adversely affect sleep, yet findings specific to children aged 6–12 years remain fragmented. Objectives: To systematically review and meta-analyze the association between screen-time duration and sleep disturbances among school-going children aged 6–12 years. Methods: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO was conducted from database inception to June 2025. Studies reporting quantitative associations between screen time and sleep outcomes in children aged 6–12 years were included. Data extraction and risk-of-bias assessment were performed using standardized methods and the Newcastle–Ottawa Scale. Where ≥3 comparable studies were available, random-effects meta-analysis was conducted to generate pooled effect estimates. Results: Of 3,214 records identified, 38 studies met eligibility criteria for qualitative synthesis and 26 studies contributed to meta-analysis. Most studies were cross-sectional, with sample sizes ranging from 214 to 18,640 children. Higher screen-time duration was consistently associated with shorter sleep duration, prolonged sleep onset latency, delayed bedtime, greater bedtime resistance, night awakenings, and daytime sleepiness. Meta-analysis demonstrated that increased screen exposure was significantly associated with reduced total sleep duration and higher odds of short sleep and insomnia-related symptoms. Stronger associations were observed for evening and in-bed device use compared with overall daily exposure. Conclusion: Prolonged screen-time duration—particularly evening and bedtime use—is significantly associated with sleep disturbances in school-going children aged 6–12 years. Limiting recreational screen exposure, avoiding device use near bedtime, and promoting screen-free sleep routines may support healthier sleep patterns in this age group.

Background: Pharmacology is a foundational subject in medical education but is often perceived as difficult due to its content-heavy and memory-oriented nature. Traditional didactic lectures may limit students’ ability to apply pharmacological knowledge in clinical settings. Case-based learning (CBL) has been proposed as an active teaching–learning strategy to enhance clinical reasoning and student engagement. Objectives: To compare case-based learning with didactic lectures in undergraduate pharmacology teaching by assessing student attendance, academic performance, and perceptions of students and faculty. Methods: A descriptive crossover study was conducted in the Department of Pharmacology at Govt Medical College and Hospital ,Sundargarh after Institutional Ethics Committee approval. A total of 120 second-year MBBS (fourth semester) students participated. Two pharmacology topics—drugs used in acid peptic disease and tuberculosis—were taught using CBL and didactic lecture methods in a crossover manner. Student attendance was recorded, and learning outcomes were assessed using a written test conducted two weeks after the sessions. Feedback from students and faculty was collected using prevalidated Likert-scale questionnaires. Data were analyzed using R statistical software, and Student’s t-test was applied, with p < 0.05 considered statistically significant. Results: Student attendance was significantly higher during CBL sessions compared to didactic lectures (p < 0.05). Overall mean test scores did not differ significantly between the two teaching methods (p > 0.05). However, students taught through CBL performed better in application-based and critical-thinking questions, while those taught through didactic lectures scored higher in recall-based questions. Both students and faculty reported positive perceptions of CBL, highlighting improved engagement, interaction, and clinical relevance. Discussion: The findings suggest that while case-based learning and didactic lectures are equally effective in overall knowledge acquisition, case-based learning offers added advantages in enhancing student engagement, attendance, and higher-order clinical reasoning skills. These results support the use of case-based learning as a complementary teaching–learning strategy in undergraduate pharmacology education. Conclusion: Case-based learning is an effective and acceptable teaching–learning strategy in undergraduate pharmacology, particularly for enhancing clinical reasoning and student engagement in large classroom settings. A blended approach combining CBL with traditional lectures may optimize learning outcomes. Further longitudinal studies are recommended to assess long-term knowledge retention and clinical competence.

Background: Postoperative sore throat (POST), cough, and hoarseness of voice are frequent and distressing complications following endotracheal intubation under general anaesthesia, with reported incidences ranging from 30–70%. These airway-related morbidities negatively influence postoperative comfort, patient satisfaction, and quality of recovery. Various pharmacological interventions have been investigated to attenuate these effects, among which nebulized magnesium sulphate and lignocaine have shown promising results, though comparative data remain limited.Objectives: To compare the efficacy of preoperative nebulization with magnesium sulphate and lignocaine in reducing the incidence and severity of postoperative sore throat, cough, and hoarseness of voice, and to assess their effect on extubation quality and hemodynamic stability.Methods: This prospective, randomized, triple-blind, controlled study was conducted on 90 adult patients (ASA physical status I–II), aged 18–65 years, undergoing elective surgeries under general anaesthesia with endotracheal intubation. Patients were randomized into three equal groups: Group I received nebulized magnesium sulphate (250 mg), Group II received nebulized lignocaine 2% (100 mg), and Group III received nebulized normal saline as control. Postoperative sore throat, cough, and hoarseness of voice were assessed at 2, 6, 12, 24, and 48 hours post-extubation. Extubation quality and hemodynamic parameters were also evaluated.Results: Demographic and intraoperative variables were comparable across groups. The magnesium sulphate group demonstrated significantly better extubation quality and a lower incidence and severity of postoperative sore throat and cough compared to the control group, particularly at 12 and 24 hours (p < 0.05). Lignocaine showed moderate benefit but was less effective than magnesium sulphate. No significant hemodynamic instability or adverse effects were observed in any group.Conclusion: Preoperative nebulization with magnesium sulphate is a safe, effective, and economical method to reduce postoperative airway-related complications and improve extubation quality following general anaesthesia.

Background: Knee osteoarthritis (OA) is the leading cause of musculoskeletal disability worldwide, affecting over 300 million people and characterized by progressive cartilage loss, subchondral remodeling, and synovial inflammation leading to pain, stiffness, and functional decline. Early-stage OA (Kellgren-Lawrence grade 0–2) offers intervention opportunities, but conventional treatments like NSAIDs and physiotherapy provide only symptomatic relief with risks (gastrointestinal/cardiovascular for NSAIDs). Platelet-rich plasma (PRP), an autologous biologic concentrating growth factors (PDGF, TGF-β, IGF-1), shows promise for chondroprotection and symptom improvement, though RCTs validating single-dose efficacy vs placebo in outpatient settings are limited. Objective: To evaluate intra-articular PRP vs normal saline (NS) placebo for pain reduction and functional improvement in early knee OA outpatients. Methodology: Randomized controlled trial (2022–2025, Government Medical College, Kadapa) randomized 100 patients (KL 0–2) 1:1 to single 8 mL PRP (5–8× platelets) or NS. Outcomes: WOMAC (pain/stiffness/function), VAS at baseline/6 weeks/3–6 months. Analyzed via t-tests/chi-square (SPSS v30.0). Results: Baselines matched (age 54.2±5.4 vs 53.2±5.4y, p=0.353; BMI 29.9±2.7 vs 26.6±2.9, p=0.559). PRP WOMAC: 60.2±4.9 (baseline) → 19.4±7.6 (6mo, p<0.001); NS: 59.8±4.6 → 68.0±4.7 (p<0.001 between). PRP sub-scores: pain 12.6±3.1→1.3±1.4, stiffness 3.5±1.2→1.4±1.1, function 44.1±3.8→16.6±6.3 (all p<0.001). VAS PRP: 5.2±1.0→1.1±1.2 (p<0.001). No serious AEs. Conclusion: PRP demonstrated superior, sustained benefits over NS placebo, supporting its role in early knee OA management.

Background: Comminuted patellar fractures, particularly AO type 34 C2 and C3, pose significant management challenges due to articular involvement and disruption of the extensor mechanism. While standard tension band wiring is effective for simple transverse fractures, its utility is limited in complex fracture patterns. Modified or multiple tension band wiring techniques have been proposed to improve fixation in comminuted cases. To evaluate the functional outcome of comminuted patella fractures (AO type 34 C2 and C3) managed by multiple tension band wiring, using the Böstman clinical grading score. Materials and Methods: This prospective-retrospective observational study was conducted at a tertiary care hospital in Raipur, Chhattisgarh, from March 2023 to March 2025. Thirteen patients aged 20–60 years with AO 34 C2/C3 patellar fractures were included. All underwent open reduction and internal fixation using multiple K-wires and stainless-steel wires. Patients were followed up at 6 weeks, 3 months, and 6 months. Functional outcomes were assessed using the Böstman score and range of motion (ROM). Results: At 6 months, 92.3% of patients achieved good to excellent outcomes. The mean Böstman score significantly improved over time (14.23 at 6 weeks, 25.92 at 6 months; p < 0.001). Complications included implant irritation (21.4%), surgical site infection (7.1%), and stiffness (7.1%). No cases of non-union or hardware failure were observed. Conclusion: Multiple tension band wiring is an effective and reliable technique for managing comminuted patellar fractures, offering stable fixation and excellent functional recovery with minimal complications.

Background Dengue fever is a major arboviral illness in tropical regions, frequently associated with hepatic involvement. Liver dysfunction ranges from mild asymptomatic transaminase elevation to severe hepatitis and contributes to morbidity in dengue infection. Objective To evaluate the pattern and extent of hepatic dysfunction in adult patients with dengue fever and to compare liver function abnormalities across different clinical severities of dengue. Methods This prospective observational study was conducted at Jhalawar Medical College and SRG Hospital, Rajasthan, from November 2018 to October 2019. Adult patients (≥18 years) with serologically confirmed dengue infection were enrolled. Liver function tests including serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and serum albumin were assessed. Patients were categorized into dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) as per WHO criteria. Data were analyzed using descriptive statistics and comparative tests. Results A total of 91 patients were included, with a mean age of 32.86 years. Dengue fever accounted for 69.2% cases, DHF for 27.5%, and DSS for 3.3%. Elevated AST and ALT levels were observed in the majority of patients, with AST predominance. Abnormal bilirubin levels were present in 16.5% of patients, occurring in all DSS cases. Hepatic dysfunction was more frequent and severe in DHF and DSS compared to DF. Conclusion Hepatic involvement is common in adult dengue infection, predominantly manifesting as mild to moderate transaminase elevation with AST predominance. The severity of liver dysfunction increases with clinical severity of dengue.

Background: Subarachnoid block is a preferred anaesthetic technique for infraumbilical surgeries. Newer long-acting amide local anaesthetics such as Levobupivacaine and Ropivacaine provide effective spinal anaesthesia with improved safety profiles compared to racemic Bupivacaine. The present study compared the clinical efficacy and safety of hyperbaric Levobupivacaine 0.5% and hyperbaric Ropivacaine 0.75% for infraumbilical surgical procedures. Aim: To compare the clinical efficacy and safety of hyperbaric Levobupivacaine 0.5% and hyperbaric Ropivacaine 0.75% in subarachnoid block for infraumbilical surgeries. Materials and Methods: A prospective, randomized, double-blinded comparative study was conducted on 70 patients (ASA I–II), aged 18–60 years, scheduled for elective infraumbilical surgeries under spinal anaesthesia. Patients were randomly allocated into two groups of 35 each: Group HL received 3 mL of 0.5% hyperbaric Levobupivacaine, and Group HR received 3 mL of 0.75% hyperbaric Ropivacaine. Onset, level, and duration of sensory and motor blockade, hemodynamic stability, and side effects were recorded. Data were analyzed using Student’s t-test and Chi-square test, with p < 0.05 considered statistically significant. Results: Both groups were demographically comparable. Hyperbaric Levobupivacaine exhibited a significantly faster sensory onset to T10 (2.87 ± 0.46 vs 4.15 ± 0.33 min; p < 0.001), longer sensory regression time (127.29 ± 8.26 vs 95.00 ± 14.04 min; p < 0.001), prolonged motor block duration (205.14 ± 18.50 vs 124.70 ± 18.60 min; p < 0.001), and delayed requirement for rescue analgesia (341.43 ± 30.60 vs 246.29 ± 34.65 min; p < 0.001). Hemodynamic parameters and oxygen saturation remained stable across both groups, with no significant adverse events. Conclusion: Hyperbaric Levobupivacaine 0.5% provides earlier onset and prolonged sensory and motor block characteristics, longer analgesia, and comparable hemodynamic stability compared to hyperbaric Ropivacaine 0.75%. Both agents are safe and effective without adversities, with Levobupivacaine better suited for longer procedures and Ropivacaine preferable for faster recovery scenarios.

Background: Supraclavicular brachial plexus block provides dense anesthesia for upper-limb surgeries. Levobupivacaine, a safer enantiomer of bupivacaine, offers long-acting anesthesia with reduced cardiotoxicity. Fentanyl has been used as an adjuvant to enhance analgesic duration. This study aimed to compare the analgesic efficacy and hemodynamic stability of isobaric levobupivacaine (0.5%) with and without fentanyl in ultrasound-guided supraclavicular block. Methods: A prospective randomized comparative study was conducted on 40 patients (ASA I–II, aged 18–60 years) scheduled for elective elbow and forearm orthopedic surgeries. Patients were divided into two equal groups (n = 20 each): Group L received 30 mL of 0.5% isobaric levobupivacaine, and Group LF received 19 mL of 0.5% levobupivacaine + 1 mL (50 µg) fentanyl + 10 mL normal saline. Under ultrasound guidance, the supraclavicular block was performed. Sensory and motor onset and duration, intra- and postoperative hemodynamics, and adverse effects were recorded and analyzed using Student’s t-test and Chi-square test. Results: The onset of sensory block was slower in Group LF (4.8 ± 1.6 min) than Group L (3.1 ± 1.1 min, p < 0.001). The duration of sensory (765.8 ± 108.0 min vs 399.3 ± 51.9 min) and motor block (656.0 ± 99.0 min vs 283.5 ± 65.7 min) was significantly longer in Group LF (p < 0.001). Mean arterial pressure and pulse rate remained comparable between groups throughout the perioperative period (p > 0.05). No major complications were reported. Conclusion: Addition of fentanyl to isobaric levobupivacaine in ultrasound-guided supraclavicular block significantly prolongs sensory and motor blockade and enhances postoperative analgesia while maintaining hemodynamic stability and safety.

Exclusive breastfeeding for the first six months of life is widely recommended, yet concerns persist regarding whether it adequately supports infant growth compared with exclusive formula feeding. This systematic review and meta-analysis compared weight and length outcomes at six months among exclusively breastfed and exclusively formula-fed healthy term infants. Five eligible studies comprising 1,893 infants were included. Anthropometric outcomes were synthesized descriptively, and pooled estimates were generated where comparable data were available. Both feeding groups demonstrated growth parameters within the normal range of WHO Child Growth Standards. Formula-fed infants exhibited slightly higher mean body weight at six months (pooled mean difference 0.29 kg), whereas differences in length were minimal and not clinically significant. Weight-for-age z-scores were marginally higher among formula-fed infants, while length-for-age z-scores were comparable between groups. Overall, the findings indicate that exclusive breastfeeding supports adequate and physiologically normal growth at six months, reinforcing recommendations to promote exclusive breastfeeding during early infancy.

Background: Medical students are at increased occupational risk of exposure to vaccine-preventable diseases due to early and repeated contact with patients and clinical environments. Adequate immunization of medical students is essential to protect both healthcare workers and patients; however, vaccination coverage among medical trainees in India remains variable and often suboptimal. Objectives: The present study aimed to assess the immunization status of Indian medical students in North Gujarat province and to identify gaps and factors associated with vaccine uptake. Methods: A cross-sectional study was conducted over one year among 250 undergraduate medical students enrolled in medical colleges of North Gujarat, India. Data were collected using a pre-designed, pre-tested questionnaire covering socio-demographic details, vaccination history for recommended healthcare worker vaccines, availability of immunization records, and awareness regarding occupational risk. Data were analyzed using descriptive statistics and appropriate tests of significance, with a p-value <0.05 considered statistically significant. Results: Of the 250 participants, 56.8% were male and 43.2% were female. Complete immunization coverage was highest for COVID-19 (92.8%), followed by Td booster (78.4%) and Hepatitis B (71.2%). Moderate coverage was observed for MMR (64.8%), while Varicella (47.2%) and Influenza (29.6%) vaccination rates were low. Female students, students in clinical years, and those aware of occupational risk demonstrated significantly higher Hepatitis B vaccination coverage. Awareness of occupational risk showed a strong association with complete immunization status (p < 0.001). Conclusion: Although coverage for certain vaccines was satisfactory, significant gaps exist in adult and occupational immunization among medical students in North Gujarat. Strengthening institutional immunization policies, improving awareness, and ensuring systematic documentation are essential to enhance vaccine uptake and ensure the safety of future healthcare professionals.

Background: Scrub typhus is a re-emerging zoonotic infection and an important cause of acute undifferentiated febrile illness in India. Owing to its non-specific clinical presentation and limited availability of confirmatory tests, the disease is frequently underdiagnosed. Serological assays remain the mainstay of laboratory diagnosis in endemic regions. Objectives: To evaluate the role of commonly used serological tests—Weil–Felix test, immunochromatographic (ICT) card test, and IgM ELISA-and to correlate their results with clinical and laboratory findings in the diagnosis of scrub typhus among Indian patients. Materials and Methods: This prospective observational study was conducted over a period of two years (December 2022 to November 2025) in the Department of Pathology, Dr. Bhim Rao Ramji Ambedkar Government Medical College, Kannauj. A total of 200 patients presenting with acute febrile illness and clinical suspicion of scrub typhus were included. Serum samples were tested using Weil–Felix test (OXK antigen), ICT for scrub typhus IgM, and IgM ELISA. Clinical features and laboratory parameters were recorded and correlated with serological results. Statistical analysis was performed, and a p-value <0.05 was considered significant. Results: Of the 200 patients, 118 (59%) were males and 82 (41%) were females, with the majority belonging to the 21–40-year age group. Fever was present in all patients. Thrombocytopenia (55%) and elevated liver enzymes (49%) were the most common laboratory abnormalities. IgM ELISA showed the highest positivity rate (48%), followed by ICT (41%) and Weil–Felix test (34%). Among IgM ELISA–positive cases, thrombocytopenia and transaminitis were observed in 75% and 68.7% of patients, respectively, showing a statistically significant association. Conclusion: Scrub typhus is a significant yet underrecognized cause of febrile illness in India. IgM ELISA is the most reliable serological test for diagnosis, while ICT and Weil–Felix test serve as useful adjuncts in resource-limited settings. A combined serological approach with clinical correlation improves diagnostic accuracy and facilitates early treatment, thereby reducing disease-related morbidity and mortality.

Background: Scrub typhus is an important but under-recognized cause of acute undifferentiated febrile illness in India, with wide variation in reported clinical manifestations and outcomes. This systematic review and meta-analysis aimed to synthesize available evidence on the clinical features, laboratory abnormalities, complications, and mortality of scrub typhus among Indian patients. Methods: A systematic search of PubMed, PubMed Central, IndMED, Google Scholar, and major Indian journals was conducted for studies published between January 2000 and January 2025. Observational studies from India reporting laboratory-confirmed scrub typhus and extractable clinical data were included. Data on symptoms, signs, laboratory findings, complications, and outcomes were pooled using a random-effects meta-analysis. Heterogeneity was assessed using the I² statistic. Results: Ninety-six studies were included in the qualitative synthesis, and 82 contributed to quantitative analysis. Fever was almost universal among patients. Common clinical manifestations included headache, myalgia, and gastrointestinal symptoms, though with marked heterogeneity. Eschar was present in only about one-quarter of patients, with wide regional variation. Elevated hepatic transaminases and thrombocytopenia were the most frequent laboratory abnormalities. Approximately one-third of hospitalized patients developed organ dysfunction, with acute kidney injury, acute respiratory distress syndrome, and meningoencephalitis being the most common severe complications. The pooled case fatality rate was 4.8%, with higher mortality observed in severe and intensive care–based cohorts. Conclusions: In India, scrub typhus typically presents as a non-specific febrile illness, and the absence of eschar is common. Significant morbidity and mortality persist, particularly among hospitalized patients with organ dysfunction. Early clinical suspicion, prompt initiation of appropriate therapy, and improved diagnostic and surveillance strategies are essential to reduce the burden of scrub typhus in endemic regions.

Background: Acute tonsillitis is a common infectious condition encountered in otorhinolaryngology practice, particularly among children and young adults. While Group A β-hemolytic Streptococcus is a well-recognized etiological agent, recent reports suggest a changing bacteriological spectrum and rising antimicrobial resistance, posing challenges to empirical antibiotic therapy. Objectives: To evaluate the clinico-microbiological profile of acute tonsillitis and to analyze the antibiotic sensitivity and resistance patterns of bacterial isolates in patients attending a tertiary care hospital. Methods: This hospital-based observational study was conducted over one year and included 120 patients clinically diagnosed with acute tonsillitis. Detailed clinical evaluation was performed, and tonsillar swabs were collected under aseptic conditions. Bacterial identification was carried out using standard microbiological methods. Antibiotic susceptibility testing was performed by the Kirby–Bauer disc diffusion method and interpreted according to CLSI guidelines. Results: Acute tonsillitis predominantly affected children and adolescents, with 65% of cases occurring below 20 years of age. A male predominance was observed (male-to-female ratio 1.5:1). Bacterial growth was obtained in 90% of cases. Staphylococcus aureus (38.3%) was the most common isolate, followed by Streptococcus pyogenes (23.3%). Higher resistance rates were observed with penicillin (30%), amoxicillin (33.3%), and macrolides. In contrast, third-generation cephalosporins, clindamycin, and ciprofloxacin showed high sensitivity, while linezolid and vancomycin demonstrated 100% sensitivity. Conclusion: Acute tonsillitis continues to predominantly affect the pediatric population. Increasing resistance to commonly used first-line antibiotics underscores the need for culture-guided therapy and rational antibiotic use to optimize clinical outcomes and limit antimicrobial resistance.

Background: Acute tonsillitis is one of the most common upper respiratory tract infections encountered in otorhinolaryngology practice, particularly among children and adolescents. Its occurrence is influenced by age, socioeconomic status, seasonal variation, and environmental factors. Despite being largely self-limiting, acute tonsillitis contributes significantly to outpatient visits and antibiotic use, especially in developing regions. Objectives: To study the clinico-epidemiological profile of acute tonsillitis in patients attending a tertiary care hospital in the Central region of Gujarat, with emphasis on demographic characteristics, clinical presentation, seasonal trends, and treatment outcomes. Methods: This one-year observational study included patients diagnosed clinically with acute tonsillitis. Detailed demographic data, socioeconomic status, presenting symptoms, clinical findings, seasonal distribution, management strategies, and outcomes were recorded and analyzed using descriptive statistics. Results: Acute tonsillitis predominantly affected children and adolescents, with approximately two-thirds of cases occurring in individuals below 20 years of age. A male predominance was observed. Most patients belonged to lower and lower-middle socioeconomic classes. Sore throat was the most common presenting symptom, followed by fever and odynophagia. Tonsillar congestion and enlargement were universal findings, with exudative tonsillitis observed in a subset of cases. Seasonal variation was evident, with higher incidence during winter and monsoon months. The majority of patients were managed successfully with conservative treatment and/or antibiotics, with a high recovery rate and minimal complications. Conclusion: Acute tonsillitis remains a common condition in pediatric and adolescent populations and is strongly associated with socioeconomic and seasonal factors. Early diagnosis and appropriate management result in excellent outcomes. Public health measures focusing on prevention of upper respiratory infections and rational antibiotic use are essential to reduce disease burden.

Background: Uterine fibroids are a common pathology among women of reproductive age, frequently associated with abnormal uterine bleeding, pelvic discomfort, and fertility challenges including recurrent pregnancy loss (RPL), bad obstetric history (BOH), and subfertility. Laparoscopic myomectomy (LM) is increasingly preferred by women seeking uterine preservation for future fertility and/or restoration of normal menstruation. Aims: To evaluate reproductive and menstrual outcomes following laparoscopic myomectomy, based on a single-centre clinical experience, supplemented by a review of the literature. Materials and Methods: This retrospective observational case series was conducted in the Department of Gynaecology at Shri Mahaveer Hospital, Raipur, from April 2022 to March 2025. A total of 28 reproductive-aged women with uterine myomas, desiring uterine conservation, underwent LM. Data were collected through review of medical records and telephonic follow-up to assess postoperative menstrual and reproductive outcomes. Results: A total of 42 cases was enrolled during the study period, distributed as follows: abdominal (± abdominal hysterectomy, broad ligament fibroids) – 6 cases; vaginal (fibroid polyp, central cervical fibroid) – 4 cases; conversions due to pouch of Douglas adhesions or vascularity – 4 cases; and laparoscopic – 28 cases. Multiple myomas were excised in 20 cases, with intramural fibroids present in 24 cases. The mean myoma diameter was 5.9 cm. Preoperative blood transfusion was required in 10 patients (8 preoperative, 2 postoperative; 2 received packed cell volume transfusions). Transfusion requirements were attributed to pre-existing anaemia rather than intraoperative blood loss. The mean surgical duration was 100 ± 20 minutes. No statistically significant association was observed between age, BMI, duration of infertility, myoma size, operative time, or myoma volume when comparing women who conceived postoperatively with those who did not. Among the 14 patients who conceived post-LM, 10 had full-term deliveries, 4 had preterm deliveries, 12 underwent Cesarean section, and 2 had vaginal deliveries. Of the remaining 14 patients, 4 are undergoing treatment for spontaneous conception, 3 are unmarried, 1 is separated, and 6 are not currently planning pregnancy. The mean interval between LM and conception was 14 months. Notably, no cases of uterine rupture were reported during pregnancy. Postoperative menstrual patterns normalized in 22 patients, while 6 reported hypomenorrhea. Conclusion: Laparoscopic myomectomy is a safe and effective surgical option for women with symptomatic fibroids who wish to preserve their uterus. When performed by experienced surgeons, LM yields favourable perioperative and postoperative outcomes. These findings support the broader adoption of minimally invasive myomectomy in appropriately selected patients.

Background: Fistula-in-ano is a chronic inflammatory condition of the anorectal region that continues to pose significant diagnostic and therapeutic challenges to colorectal surgeons. Despite advances in imaging and sphincter-preserving surgical techniques, recurrence and postoperative incontinence remain major concerns. Accurate delineation of fistula anatomy and selection of an appropriate surgical procedure are critical determinants of outcome. Objectives: This study aimed to evaluate the clinicopathological profile of patients with fistula-in-ano, assess the role of imaging—particularly magnetic resonance imaging (MRI)—in preoperative planning, compare various surgical modalities, and identify factors influencing postoperative recurrence and continence outcomes. Materials and Methods: A combined prospective and retrospective observational study was conducted at a tertiary care teaching hospital in central India over a defined study period. A total of 100 patients diagnosed with fistula-in-ano were included. Detailed clinical evaluation, per-rectal examination, proctoscopy, and imaging (MRI, fistulogram, and endoanal ultrasonography where indicated) were performed. Surgical management was individualized based on fistula anatomy and included fistulotomy, fistulectomy, seton placement, LIFT procedure, and advancement flap repair. Patients were followed up for recurrence and continence status using the Cleveland Clinic Incontinence Score (CCIS). Results: The mean age of patients was 38.6 ± 11.2 years, with a male predominance (M: F = 2.4:1). Discharging perianal sinus was the most common presenting symptom. Intersphincteric fistula was the most frequently encountered type (46%), followed by transsphincteric fistula (38%). MRI demonstrated high concordance with intraoperative findings for both internal and external openings. Overall recurrence rate was 12%, with significantly higher recurrence in complex fistulas and sphincter-saving procedures. Postoperative incontinence was observed in 9% of patients, predominantly in those undergoing sphincter-cutting procedures. Conclusion: MRI plays a pivotal role in accurate preoperative assessment of fistula-in-ano and significantly correlates with operative findings. Surgical outcomes are influenced by fistula complexity, comorbidities, and choice of procedure. Individualized surgical planning balancing eradication of disease and preservation of continence remains the cornerstone of management.

Background: Childhood obesity is the current public health concern in low and middle-income countries. Obesity is considered a disease modifier of respiratory disorders like asthma. Peak expiratory flow rate (PEFR) directly indicates the child's nutritional health apart from its role in assessment of lung function. PEFR has helped to reduce the frequency and severity of exacerbations of asthma and improve quality of life. This study was aimed to establish the relationship between the Peak Expiratory Flow Rate and Body Mass Index(BMI) among obese and non-obese adolescents. Methods: This was a case control study done on adolescents between 14 and 17 years from urban schools. Schools were selected by stratified sampling method and one school was selected from each zone adjacent to study centre. Obese adolescents were cases and non-obese were controls. Anthropometry was recorded and body mass index calculated. Peak expiratory flow rate was measured using mini-Wrights peak flow meter. BMI was compared with PEFR using independent sample t test. A p value <0.05 was considered significant. Results: Among the 200 students studied, there were 100 obese and 100 non-obese adolescents. The mean (SD) PEFR among the obese students was 251.90(16.74) and among the non obese students it was 329.90(22.18), (p<0.0005). The mean (SD) PEFR values were higher in the boys as compared to the girls. Mean PEFR values were lower in obese adolescents as compared to non -obese adolescents in all the four age groups studied. Conclusion: The present study observed that obese adolescents had significantly lower mean PEFR when compared to non-obese adolescents. This observation was uniform throughout the various age groups studied. Similar observation was seen in obese boys and girls when compared to their non-obese counterparts. The association between BMI and PEFR indicates that being obese is a significant risk factor that may alter lung function in the pediatric population.

Background: Supplementary Immunization Activities (SIAs) play a pivotal role in accelerating measles–rubella (MR) elimination by boosting population immunity and improving surveillance sensitivity. Over the past decade, the MR surveillance system in Greater Mumbai has undergone key enhancements—including the shift from aggregate outbreak-based surveillance (2013), initiation of case-based surveillance (2019), and introduction of fever-rash surveillance with a simplified case definition (2021). This study assesses the impact of SIAs on MR outbreak detection indicators from 2013 to 2025. Methods: A retrospective trend analysis of MR case-based surveillance data was conducted. Indicators included fever-rash case reporting, timeliness of outbreak investigations, specimen adequacy, virology sample collection, and the non-measles/non-rubella (NM/NR) discard rate. Surveillance performance and laboratory-confirmed outbreaks were compared across three periods: pre-SIA (2013-2016), SIA implementation phase (2018–2019), and post-SIA strengthening phase (2020-2025). Results: Marked improvements in surveillance quality were observed post-SIA. Investigation timeliness surpassed 90%, specimen adequacy consistently exceeded 80%, and virology sampling rates rose to >80%. The NM/NR discard rate improved substantially from 1.2 in 2019 to 8.9 in 2023, reflecting heightened surveillance sensitivity. Measles-positive outbreaks declined from 32 in 2018 to zero or one annually by 2024-2025, while rubella-positive outbreaks were eliminated after 2019. Laboratory-confirmed case counts for both diseases declined sharply following SIAs, corresponding with strengthened outbreak detection and expanded laboratory integration. Conclusion: The 2018-2019 MR SIA significantly enhanced surveillance sensitivity, reduced outbreak occurrence, and contributed to sustained MR control in Greater Mumbai. Continued reinforcement of surveillance systems, laboratory capacity, and periodic SIAs remains essential to safeguard elimination achievements and prevent resurgence.

Prosthetic joint infection (PJI) remains a major complication of arthroplasty, and a considerable proportion of cases present as culture-negative infections, creating diagnostic uncertainty and therapeutic challenges. This systematic review and meta-analysis compared the clinical characteristics, management strategies, and outcomes of culture-negative and culture-positive PJI. A comprehensive literature search of studies published between January 2000 and December 2024 identified 18 comparative studies including 6,214 patients, of whom 1,182 (19.0%) had culture-negative and 5,032 (81.0%) had culture-positive infection. Culture-negative PJI was significantly associated with prior antimicrobial exposure (58% vs 24%; RR 2.41; 95% CI 1.88–3.09), and empirical broad-spectrum or glycopeptide-based regimens were more frequently used in these cases. Surgical strategies such as debridement-antibiotics-implant-retention and staged revision procedures were applied at comparable rates in both groups. Overall treatment outcomes were similar, with no significant differences in success after two-stage revision, failure following DAIR, or mortality rates. These findings suggest that culture-negative PJI represents primarily a diagnostic rather than prognostic challenge, with outcomes comparable to culture-positive infections when evidence-based surgical pathways are followed. Improvement in microbiological yield, optimization of sampling and processing techniques, and antimicrobial stewardship remain essential to enhance the management of this clinically important subset of PJI.